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� <br />' PERMIT AP'PLICATION <br />CITY OF EVERETT PEHMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 -- FAX 425-257-8857 - www.everettwa.org <br />APPLICATI7NS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SI?E 4DDRESS I <br />r.� c // Z��` ){ S. W. <br />L[GAL LOT NO. BLOCK <br />DESC f ... /.i�,.._I_a, <br />TRACT <br />PARCEL TAX I.D. N <br />�G/ <br />Jo -oN�6 <br />I rE`�n�" , <br />, iS'/_ In. <br />CITYIZIP PNONE <br />(ti�v� +� t.�l��. C��t�Y� O� Si�v Cc �0 &.x l3U(�G Gveiu(�- ��U(, � <br />TENANTNAME I CONTACTFORPERMIT PHONE I <br />� 1 <br />�'��naM ��t..l:�. C<ti.:�r ��.v..+`W. Mf.c-v.G_ ��r7-�Jo.2- ��s%� _ <br />CONTRACTO�R�/ ADDRFTSS CITYlZIP PHONE � <br />/11a..i'� /�'F<��w..t�� T✓.CG. rlr>L� /1�.•'1lvt /�/C pib��t-�C� �lrSU)i 'lZS �SYi -12Z'/'i <br />/es <br />CONTR. LICENSE N � <br />' USE OF BUILDING <br />�ia./��. L-P.�.iC/ <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Y r..s <br />Eleclric /` Gas Othe� �`'S G�� '� <br />_ — i <br />'i WORK DESCRIPTION _ � <br />�,_....,�.// ��✓M%..,5 /--L�..-� s <br />PLUM611V(i <br />NO. I TVPE OF FIXTURE OR ITEM <br />� Totle� <br />BathWb <br />� Lavatory (wash bas�n� <br />Shower <br />Kdchen sink & disposal <br />� Dishwasher <br />Clothes washer <br />� Laundry tray <br />Sink (sernceroadmop/etc 1 <br />BackBow preventer <br />� Urinal <br />� Drmkingfounta�n <br />� Floor drain <br />Grease trap <br />Roof drains <br />� O�h¢� ��n';� i�i��i� <br />NO. <br />� <br />�o/�it�.�.v.;.�,� �,�,.��,5 <br />MECHANICAL <br />TVPE OF FIXTURE OR ITEM <br />AIC - av hantlhng unAs <br />Forced av systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />l;as range <br />Clothes dryer <br />Range hood <br />Exhaust lan <br />lieat pump <br />Unit heater <br />Boder <br />Refngeralion <br />Woodstove <br />Other <br />CIN OF EVERETT LOCAL SALES TA% CODE IS �106 <br />I he�eby cenidy lhat I have read and e� am�ned this appl�ca0on end I:now the same to be tiue end correa All provisions of laws and <br />ordinaces governing this lype of work �anll be complied with whether specified herein or not The granting of a pertnit does nut presume <br />to grve aulhonty to violate or cancel tl�= provlsion ol any ot:ier state or iocal law reguiatmg construction or ihe perfortnance of <br />r.onsiruction That I am authonzed b�� the owner ol Ihis property to pedorm the work lor which applicahon is made and I comply wlih the <br />State Conliactors Law iB 27 RCW a id 296 200 WAC <br />�f:'-f� ���/^� C � ��% tI'"CjS�__ <br />Signature ol Owner onlrectonAa(honzed Agent Date <br />- - � <br />