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�'cRMIT APPLICATlC,�N I <br /> CITY OF EVEREl"T PERPJIIT SERVICES <br /> 3200 CEDAR STREE�, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - wwv✓.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM + � a b -o � <br /> SITE ADDRESS PARCEL TAX I.U.# PERMIT# <br /> � � � -D <br /> . ;�� ��� i% �-� ��.-rt �>>;i < •^,/,>� � <br /> LGGAL LOT NO. BLOCK TRACT OR S11B01VISION# I <br /> DESC. <br /> OWNER ADDRESS GITYIZIP PHONE <br /> ' _ I ' <br /> , i'. t i-,-� � � i. � / I <br /> TENANT NA�dE CONTACT POR PERh71T PHONE ''�_!��' � � - t�'�l- CFL" � <br /> . il��lj.;�.� �iL�'I�n, .._ E-MAIL ( L'�: I'�.lio«i✓l�� �c;.i�; .,.. <br /> I CONTftACTOR � , ADDRE55 �- ';7 , , �',CITYlZIP PHONE 7� U (>-l ' b�'<'.c� <br /> �b11.�, �C.�:SfJ:�{lc.� - Ic. , <br /> ' '�'L'._�'�._�.I i , � � , , _ <br /> CONTR. LICENSE#;����� ��*��J�:; ,, <br /> , /n��/�i) -. <br /> USE OF BUILDING HEAT SOURCE CONTRAC�!PRICE OF WORK <br /> _Eleclric _Gas_Olher fl�(��� <br /> WORK DESCRIPTION i������� ,,. ;_/.,���ci l . 'Go"cc_- hc°��.icJc� �I���9: 1 ��,,.;_ �. i��i e�[{J��i%u� i <br /> ��1.,..i.�1. ,����:(� I�' ':� �.. , � ._ 1�C.' , �, i�t ' <t •.''ul Cc;CI�� _ � <br /> PLUMBING MECHANICAL <br /> N0. I NP[Of FI%TURE OR ITEM NO. TYPE OF FIXTUP.E OR ITEM <br /> Toilet A/C-air handlin� units <br /> � Balhtub _ Forced air systems <br /> � Lavalory(wash basin) Gas piping <br /> Shower � VJaler heater <br /> � Kilchen sink 8,disposal \ _ Gas fireplace <br /> Dishwashcr � Gas range <br /> � Clothes washer „`r� � Clothes dryer <br /> � `-' Ran e hood <br /> W aler healer 9 <br /> Sink (service/badmop/etc.) � �;:- '7� Exhaust fan <br />� _ Backflow prevenler ��� �� _ Heat pump <br /> Urinal � . �'� Unit heater <br /> i _ Drinking Fountain ;_,?�' _ Boiler <br /> Floor drain Refrigeration <br />' I Grease trap _ Woodstove <br /> j Roof drains _ Olher_ <br />� _ Other — , <br /> I � <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> II hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> Iordinaces yoverning this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> Ilo yive aulhority to violate or cancel the provision of any other state or local law regutating construclion or the per(ormance of <br /> �:onslruction. That I am authorized by the owner of this property to perform lhe�vork(or which application is made and I comply with the <br /> I Stale Contractors Law 18.27 RCW and 29G200 WAC. _ - <br /> i <br /> i <br /> l'� ' . � i 1 � � � u, � �,� 7�:nY <br /> ��, Signature of OwnedConUaclodAulRo�dzed Agenl D2te / <br /> I� �lL <br /> �-- ------------ ------- <br />