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. P'=RMIT APPLICAT�r''N <br /> CITY OF EVERETT PERMIT SERVICES , <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FNX 425-257-8857 - www.everettwa.org <br /> ;� �� � > �f �-� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> �� OZ�IO J/7OO�Z//�(%D C I � ' �C(i <br /> LEGAL LOT NO. BLOCK TRACT OR SU�DIVISION# <br /> DESC. <br /> OWNER ADDRESS CIN/ZIP PHONE <br /> 7i"nvrdc��c� yY(edi� ��r /30?l ���j/9t/� i IIc.�V�� 9�o//yas)a�/_�Ss�� <br /> TENANT NAME CONTACT F PERMIT PHONE 9 c�.at�g. �O� <br /> � / ,, � � U',7 7 �/' /� <br /> �l F1I-��`--�'�_ /V�G/L ��� E-MAIL �5�(''���SI�'I/�h}[YG^� <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE � <br /> ��,i�<� Gr��s���5 ��a�- s��v� �, iace,� y�`ta�f <br /> CONTR. LIC[NSE p <br /> 5�,-i �n-iFsi3�oT - - - - �53 -9a� -lGS� � <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK I, <br /> �� ' • � i c ' I � °� <br /> IC,C ,C a l �-rC _-- �leclnc _.__ Gas ---- U�her � � `, / �T J C" ', <br /> ---�-- �-- ---- --- � <br /> WORK DESCRIPTION ��. <br /> � /� <br /> . <br /> f� n�,�c� �{i; �/��Ic. ��, S � � /Ai'-� G2 � �1/�y'. 1I� �', . "fL�"C✓�- / ! - .l=� "� �� ���� ',I <br /> J <br /> i <br /> — � - ---- - -� �-r----�-------- --- - <br /> PLUMBING MECHANICAL � <br /> NO. TYP[OF RX7URC OR ITF1d NO. NPE OF F�%TURE OR ITEh1 � <br /> Toilet _ NC - air hand6nc7 units I <br /> _ �alhtub Forced air systems i <br /> Lavatory (wash bas�n) Gas piping <br /> Shower _ Waler heater �i <br /> Kdchen shik & disposai _ Gas Greplace <br /> Dishwasher _ Gasrange <br /> = Clothes washer Clothes dryer I <br /> Water heater Range hood <br /> Smk (SeiviCe/62dmople�c 1 _ Exhaus� �an <br /> _ 6ack(Iow prevenler ___ f leat pump <br /> Urinal Und heater <br /> Dnnking Pounlain _ Boiler <br /> Floor drmn .. �efnycralwn <br /> Grease irap _ Woodslove <br /> Roof drains _ Other <br /> O�her -- ---, <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> i <br /> I hereby rertify Ihal I have r.ad and eaannned ihis apphcation and Y.now ihe same lo be Irue and correcl All provisions o�laws and <br /> ordinances goeerniny this t�pe ul woik will be complied with whe�her spea(ed herein or nol The granting ol a permil does nol presurne <br /> to grve aulhority Io violate o�cancel Ihe provision ol any other slate or local law regulafing construc�ion or the peAonnance o( <br /> constiuction 7h�ll I am aulhonzed by �he ov:nei of Ihis property to periorm Ihc work (or r�hich applicahon is made and I ^omply wdh ihe <br /> State Conlraclors Law 18 2�' RC1N and 296 200 WAC <br /> � , � � L�i,��,'1/IN��,����' " �_ / l I <br /> S�ynalure of OwneriContraclorL ulhonr_ed Agenl ate <br /> ���, � <br />' _---- --- - <br />