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I <br /> PErdMIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROti1 8 AM 'f0 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AD�RESS �y/� ��� Si PARCEL TAX I.D.# PERMIT# <br /> � _, -�. ��. m a+o�-oZ3 <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER I <br /> ,�-� ADDRESS CITY2IP PHONE <br /> ti[/�c�,�� fl, /l /%%� /�,2 %.�'S.— �--�>r.�_'�<< �' �� ._ = 3�- % <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> / <br /> ��.R/''Il ���G'�!�{ �� / � )1 _���' ,� <br /> CONTRACTOR J � /!�J cti�i�%J'J� <br /> �./��J7�f✓���-�r�(�4DDRESS ��,/ ����CITY2IP PHONE , <br /> / <br /> CONTR.LICENSE# C/ �� �� / ,� � <br /> �/-t�cJ�- v2G�C �E- i4`7 ��5 ,��/"v-`Sr� 1'n�Sl�i�'v' <br /> USE OF BUILDING �7�9��\ I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> J ElecMc Gas Other <br /> woRK oescRiPnoN ��VC%T �4�� �/_= ' /.f1Gy �I�C-��� C G ffizJZ f -/� <br /> � <br /> . <br /> PLUMBING MECHAPIICAL <br /> NO. TYpE OF FIXTURE OR ITEM NO. TYpE OF FIXTURE OR ITEM <br /> _ Toilet A/C-airhandlingunits <br /> _ Bathtub Forced air systems <br /> _ Lavatory (wash basin) Gas piping <br /> _ Show•er � Water heater <br /> _ Kitchen sink&disposal Gas fireplaca <br /> _ Dishwasher Gas range <br /> _ Clothes wzsher Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink (service/barlmop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br />' _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> I = Other = <br /> � CITY OF EVERETT LOCAL SALES 7A:C CODE IS 7105 <br /> � <br /> ' I hereby ceritify that I have read and examined ihis applica6on and know the same to be true and correct. All provisions uf laws and <br /> j ordinaces governing :his type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to vioiate or cancel the provision of any other state or local law regulating construcUon or the performance of <br /> construction.That I am authorized by the owner of Ihis property to perform the work for which application is made 2nd I comply with lhe ' <br /> State Contractors Law98.27 RCW and 296.200 WAC. ! <br /> I <br /> q ' 4 / - �� -1 �..�� <br /> � �(���Il.�(� ���j""�� �����J�/�-"/� � <br /> Signature of OwnenContractoqAuthonzed Agent � Da[eT-� <br /> I <br /> I <br />