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i SITE ADDRESS <br />�I I [GA� LOT NO. <br />i DGSC <br />OWNER <br />I /r <br />. I`.yr• iTr-- <br />� <br />PERMIT APPLICATION <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 FROM 6 AM TO 4 PM <br />PARCEL TA% I.D. M <br />r.' , l - <br />-_ /�:'�7%%(,(l�J!>Tf.:(i_; <br />BLOCK TRACT <br />i, <br />�ERMIT It <br />1/ '�' I.'; j <br />.JJRESS CITYI2IP PHONE <br />TCNAfIi NAME I CONTACT FOR PERMIT PHONE <br />.: i' - ; � l. ,'C,�. i � / �C1'� �i , C �/ f � /� , . . ?i i . �G / -i / � S 7 � <br />CONTRACTOR ADDRESS <br />/1 .� J�-i(�.�5�� �-�C..�y��i-tf� ��f�[.,il /,��C SL( <br />CONTR. LICENSE R � <br />,�_� <br />L L ' y' .!� .�7� � � �_I � <br />USE OF BUILDING I HEAT SOURCE <br />� CITV2�P PHONE <br />7 � // -�`t l � �/c'��Sl <- <br />/ � SO �i (. 1�.; ( C <br />.� <br />WORK DESCRIPTION <br />� <br />/ <br />%- �' f <br />,� �,/ /,'�rc <br />C� C( 4 , 1 �� . <br />PLUMBING <br />NO. I TVPE OF FI%TURE OR ITEM <br />Toilet <br />Dalhtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen smk 8 disposal <br />Di�� •�asher <br />� s washer <br />La�,.Jry iray <br />Sink (servicelbar/mop�etc ) <br />fiackflow preventer <br />Unnal <br />Drinking Pountain <br />Floor drein <br />Grease trep <br />Roof drains <br />Olher <br />—� — <br />__ Electnc _ Gas _ Other <br />CONTRl�CT PRICE OF WORK <br />�a� � ��� �� <br />- �;s�,✓ .�:.,1 :_'., �l � �ds�'�/«/ <br />. <br />MECHANICAL <br />N TYPE OF FI%TURE OR ITEM <br />NC — air hantll�ng urots <br />_ Forced air systems <br />_ Gas piping � <br />Water heater �. <br />Gas Greplace ' <br />Gas range <br />Ciothes dryer <br />Rangeliood <br />E■hausUan <br />Heat pump <br />Unit heater <br />Boiier <br />Refngeralioa <br />Woodstove <br />Other <br />I CITV OF EVERETT LOCAL SALES TA% CODE IS J105 <br />i <br />i I hereby cenUry ihat I have read and exam�ned th�s appl�canon and know Ihe same to be lrue and correct All provisions ol laws and <br />Iordmaces goveming Ihis type of work wtll be complied with whether specifieA herein or not The granimg of a permil does not presume <br />to grva authority to violate or cancel the prov�sion ol :fny other state or local law regulating conslruction or the performance ol <br />I construction That I am authorized by Ihe owner of this property to pertorm the work foi which application is made and 1 r,omply wdh �he <br />� State Contractors Law 79 27 RCW and 29G 200 WAC <br />i G �. <br />� ,4 .i� .����i . ' /C �f � �- <br />I �iy�ia�mnoivwpm�w <br />% <br />�. <br />� <br />L <br />LF <br />