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E �RMIT APPLICATI � iV <br /> CITY OF EVERETT PERIUIIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ..3 <�5 < �--,�� � ( _ � � , • � <br /> G 1'� -'�'�- .> `i�` ��1 3�J Z: j c� o o ',q i ,::� �- t: ,�. i <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. �` /S � 3 �iG�'.. � . <br /> OWNER DDRESS CITY/ZIP PHONE <br /> �o0 7�.�:�;e.. Q.u-e.. 9 g�o � <br /> TENANT AME CONTACT FOR PERMIT PHONE <br /> ZOlo-.?�8'8 71'�7 <br /> CO��C'�x� �i ��o�e.� �RE�� �• �� CITY/ZIP E-MAIL�7 H94Y�j��alQ� •�'d"t <br /> dIV'�' <br /> �a�� ��-c- . 'S��000 S,i 3 `f� �.�, f1�-��_e', G(��4 �f Q l�g <br /> CONTR. LICENSE D 6 �'�" g -�7,T 7 <br /> ffo,��4 t�pr 3 79�a � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� Electric ✓Gas Other J!'p Zj O O . o 0 <br /> �.c'�`"ti'-) — — , <br /> WORK DESCRIPTION � i) �-e,��� CI� cy� � ��c..�t�.c-.t- -����`'*� <br /> �-�2.-, �2J —�Ca-�-�--`� �, C�� .�e.�. .�- " .�-,�-����, ��) 1 <br /> C��.-s.� .�-1�.�- M u f� �c��,�., �) �C.c�c_-c,c�e,�_v /�C.�-�.n.� .�c.�-.��Q. h-�� �-�-��-�I, z�J <br /> �U ��-�-h�� �c�-e� ' . a <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet "/- A/C-air handling units <br /> Bathtub r Forced air systems . <br /> __ Lavatory (wash basin) L� Gas piping y�D'hx�u✓ ��"-�-. <br /> Shower Water heater U U <br /> Kitchen sink&disposal Gas firepiace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink (service/bar/mop/etc.) 1, Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal � Unit heater <br /> � Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains � Other f�.�-l�.L. �,�i..e�.�.��d'°"�- <br /> Other � �c�'.Q.Q,�,�s��.�J .sz�/..a�'f�e-e�r�. <br /> / 7r�k�u�r� C�%•, 'L��- <br /> r ,f}G�..�� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. Ali provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> �- C�.�.p-Q. � /� /a <br /> Signa f Owner/Contractor/Authorized gent ate j �/ <br /> � �. : <br />