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' • _,�.� <br /> �'^�� � , <br /> . ,��.. ,� `. ,�'., 4 <br /> � .._ . . .. � ,'..� <br /> -- � !' PERMIT APPLICATION <br /> ,`i��`�- °'�'�°� ` � �`er�� CITY OF EVERETT PERMIT SERVICES <br /> LiC w()RK� 3200 CEDAR STREET, EVERETT, WA 98201 <br /> UB 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 /> �v�z:., �����a:��:� l�v� y 3�i C���T i 3�> t, � �c� ",�X) <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDNISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �v��C=•T� � c r'y t��r 3���� wc-:.v�v��1-- �vC::� ��s���"T,v�;�i <br /> TENANT NAME CONTACT FOR PERMIT PHONE 1,y�_ �-,�(y L,�t.�-�, <br /> �:�y" '�i i-t i�(_1=S�`+ " -"I <br /> � 'L-N�C�� F�L'C��il � ��11� E-MAIL �� ' SL��,/� �. �t� ��' JJ <br /> CONTRACTOR ADDRESS CITY/ZIP HONE � <br /> l un <br /> ��T- tlC�c:t� :�.r.i.� pi.-.C: Si:v�S , (r1b�� ��7►t �VCS � ,�j�;A't1�-L, �.C. l 7Z�•C���-(�; <br /> CONTR. LICENSE# v�� <br /> �T�ic:�C,l7��cu'�'�'c�C�.�..� ��z���/ � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION ��,j,, ��`a �.,ti 3� �- E�..��,�, <br /> �'-]�:i.� {��r :3 L,r��,. �, Z�r� �=��liC..�. <br /> �,,.::..e�;,'��j`� �Ot.i 5'`FS��i� �A� S�'ia� f�a;v C.0 N Lyt.:�=y t—L-, <br /> �:�3ctc� S;G-C.-t�= i t..,�'t�tt�1�� . <br /> PLUMBING , <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 --�-' ��(ZL �w1'�'��g�'` ' <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer _ Heat pump �.�S'�y'V\ i ti <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler �u:t�;yc�t_ ��C'c:�i <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <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 specifed 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 W C. <br /> � -�--� ��- -�f`�----��,.��� � ZC�;'lll <br /> Signature of wner ontractor/Authorized Agent - Date / l <br /> � �. <br />