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PE: .MIT APPLICATIO� _ <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 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> Y�C, �i r�! .. �,� �I .J v�- U�? <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ��/'', ��� ��'�!� <br /> TEN NAME CONTACT FOR PERMIT P �� y� �i <br /> 'a L/lJ`' J:.� // <br /> � � � <br /> ��° �� :,�JC�lG i�` (-C�l��v� �r;:("� � �' !!✓�- E-MA I L ,�c;�c c' ��iF'�'!C"�l�s e7°%' �, <br /> � <br /> CONT{'�j ACTOR ADDf� S �J /� CITY/ZIP PH� E �-'� <br /> ACY�.,�`'�r(��z.` ��I,<G2,�',/�l`�. _�.G' J.i%/ �'.�-,<f,i;JN ��. 'a=,e %�'- '"%�� l�S '�.S'.S�-����/S� <br /> �'v ,r <br /> CONT LI�E�IS�_ � <br /> ,��l��)`.��- .1L.�C°�C`�'��/,�-�� <br /> USE OF BUILDING ,, HEAT SOURCE CONTRACT PRICE OF WORK <br /> ; <br /> � <br /> ��C, rL(, i�;' ���Y��'�,+� _Electric _Gas_Other ���. C���} <br /> / � <br /> WO�K D��RIPT�ON �� / '� �' ,.,,,(�� //_� �,� <br /> / C� / �l`_� ��C':Y.'v.•,lv'/`.�-•_ ifi!`�`G�'�� '7-�N � dJ= 'i C � <br /> e� <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 Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink &disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodst ue �' <br /> Roof drains �'` - Other �f� J•����6�'�`y�� <br /> Other <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. All 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 aut rity to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> constructio That I am a thori d by the owner of this property to perform the work for which application is made and I comply with the <br /> State Corjt ctors Layv�B!27 CW and 296.200 WAC. <br /> �l � ` � <br /> �---_-"- ! ��� � <br /> Sign ur of Owner/Contractor/Authorized Agent Date �l � <br /> Z <br /> ��.._ r.. <br />