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. � _ . . <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PE MIT# <br /> /�i�ibl 2�� Oo -�oi-�� -02 -2 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. �G � <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> r,V��-{� ��G��o l J�i�r� -�Z 37/5 0��� ��. �it/�� ��ZQ� �5�38 - �f-I 9 a <br /> TENANT NAME CONTACT FOR PERMIT PHONE l�� 2� 3(L ( <br /> �� � . /�GLII ����� ��kP/j�Y(�i�/� E-MAIL kCNI l SCi�I�����'�/1�1G1�1�1� � <br /> CONTRACTOR ADDRESS f CITY/ZIP �O E � <br /> CONTR. LICENSE# �rj D ��(l[l L r � ���'��fi�C /'_ _"` -�,�-" �CYCaL (" " �`�� "�l�� <br /> �'�OCp �St�i �(�0�3 �w�E wi/��- `��l�'� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> p�/-�j��� C`Gj fs 1/D-��s � Electric __ Gas___ Other ��oQl �0 • <br /> WORK DESCRIPTION <br /> I�e-�a�fi� C4)Px�s�-r �° pr"�fi�6� ��rs��s� ��uc�� �dJ �.�/ <br /> �fi��1.� GG�ss�rYv wz � l���. (� y+.� , 1 e�-- fiY� �Cc r�-� s, <br /> p SJ p � � � p � <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 flreplace <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 ___ 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 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 ontractoxs Law 18.27 RCW and 296.200 WAC. <br /> — l � �ib <br /> Sign tu e o OwnerlContractor/Authonzed Agent Date f , <br /> �� . <br />