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PERMIT APPLICATION <br /> CITY OF EVE62ETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-E�810— FAX 425-257-8857 —www.everettwa.org //`Q�_�� <br /> APPLICATIONS ARE ACCEPTED FP.OM 8 AM TO 4 PM //�iJ O�J/� ' OaO <br /> SITE ADDRESS PARCEL TAX I.D. 4 /P/ERMIT# <br /> IG'( � ' �;, !i •., I �U� ����:��lJ� `'1,�� l: �/D - (,/� <br /> LEGAL LOT N0. BLOCK TRA�CT/�OR SUBDIVISION# <br /> DESC. .,Y- I O� � �) C� - U?�� 'ti c T �"� <br /> OWNER 4DDRESS CI7YIZIP PHONE <br /> >OfJ 2�50 <br /> I -,ll,ill�i��.� ,(' .�,,:� n(l- ."1,,',:z. t.'_i;��<�/�. �. �. ;.,�r.ft y;Z%3 <br /> 'lENANT NAME CONTACI'FOR PERMIT PHONE - <br /> �;_5- /5-y_�ir✓ <br /> IIY� 1 . �' nn,i-.< �.•_ -; � _ /l�L l.j F_��INAIL <br /> CONTRACTOR ' ADDRESS i CITYI2IP PHONE <br /> CONTR.LICENSE N <br /> 1-,��f �'� `��% n^ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ts^ n Elecfric Gas Other � � � ��, �� <br /> •1' .��� — — — --- � � <br /> WORK DESCRIPTION <br /> D�,�a n�._.� i�v7 �4 F� ;�.,�t� F��..�.� r��.��..N,�_� <br /> o�'� c_�oZ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �_ Toilet A/C–air handling units <br /> _Z Balhlub i Forced air systems <br /> � Lavatory(wash basin) . �� i� Gas piping <br /> i ,,=_ Shower � Water healer <br /> � Kitchen sink 8 disposal � Gas fireplace - P��p�ni <br /> � Dishwasher Gas ranc�e <br /> � Clothes washer i Clothes dryer <br /> '<. Water heater �_ Range hood <br /> _ Sink (service/bar/mop/etc.) i Exhausl fan . / <br /> Back(low prevenler Fleal pump <br /> Urin21 Unit heater . � � <br /> I = Drinking Fo�nlaii� = Boiler _���' � <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> _� Roo(drains _ Olher <br /> Olhcr <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hcreby cerilify Ihat I have read and examined this application and know the same to be lrue and wrrecL All provisions o(laws and <br /> ordinaces�overning this type of work will be complied with whelher specified herein or noL The grenling o(a permit does nol presume <br /> to�ive aulhority to violate or cancel the provision ol any othcr stale or local law ragulating construclion or the performance of <br /> construction.That I am authorized �y the owncr of Ihis property to perform the work for which application is made and I comply with the <br /> Stale Coniractors Law.1827 RC4V an�2�6.200 WAC. <br /> /_��..f,�,��-✓F� /��_I /7 ,zoo9 <br /> Signature of OwnCr/ entractor/Authonzed Agent Date // <br /> I- ---- - — �� <br /> l <br />