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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—wow�.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /�...��Q� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI # <br /> C��a� a�r� a�o v�,� o�v ! C� /� i�- � <br /> LEGA LOT NO. / BLOCK TRACT OR SUBDIVISION# /, , ' � �p J �� <br /> DESC. �V � � �Ci� �L�Gl.�vwl �T�''+� W_-f-- <br /> OWNER ADDRESS TY21P PHONE <br /> �c�.c,I�FIG C���� m���.� (' i��x� a�rc! p;�. l,��. �,��r'�;�t, � �' ��� <br /> TENANTNAME CONTACTFORPERMIT PNONE�� . �� 'v] , q i 1 (� . <br /> _� <br /> �Llh-�� I �� I.YL�..='I 1 � J�-1��f IL 'J�,j.J��GI �( L/�,� E.Ma� �ess�c:.a.h�a �' LW <br /> CONTRACTOR /�(� AOORESS CIN21P PHO <br /> � � 5����wms �r,c� � ���,; 5� Ft,tie. /��, 5 "� 5"��-�ly� I <br /> CONTR.LICENSE k�n I n C`I� ��v/' �j� �(,`�G I I NI.� � 1,' �C�Q <br /> I"1 I< `-'��`� <br /> I�SE OF BUILDING , FiEAT SOURCE CONTRACT PFiICE OF WORK <br /> �j i���j�U�� _Electric �Gas_Olher �I-+ � �C' �� <br /> WORK DESCRIPTION ����-Q I� C I � '� L 1� �rJ� � '�' C,(/J'{"�I�}�� �� ��r �� `Un I�G <br /> ��,��i+ ��, 5�.��✓c,r r��►� , out-,.��r ��r�� � ����� t�e �,�s-t-� i «� � r� � <br /> ��c - c�:��-r (�ad �-u����!��i���t�l l ��-Fr � �jc:��f ion �� C�n I�.n. � <br /> PLUMBING MECHANICAL � � �C� � <br /> NO. TYP[OF FIXTURE OR ITEM NO. T/PE OF FIX7URE OR ITE1�7 <br /> Toilet � A/C-airhandlingunils <br /> 6athtub Forced air systems <br /> Lavarory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposa Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Rar�ge hood <br /> Sink(servicelbar/mop�e�c.) Exhaust tan <br /> 9ackflow preventer Heat pump <br /> Urinal Unit hea�er <br /> Drinking Founlain Boiler <br /> Floor drain _i Relrigera�ion <br /> Greasc trap Woodstove <br /> Roof drains Other <br /> Other _ - <br /> CITY OF�VERETT LOCAL SALES TA7C CODE IS 3105 <br /> I hereby ceritity that I have read and examined this applicalion and know ihe same ro be true and correct. All provisions ot laws and <br /> ordinaces governing this type of work will be complied with wh:ther specified herein or not.The granting of a permit does not presume <br /> ro give authoriry to violate or cancel Ihe provision of any other slate or local law regulating construction or the pertormance of <br /> constmction.That I am authorized by thc owner of this property to pertorm Ihe work br which application is made and I comply with the <br /> Stat Contractors Law 78�7 FCW and 296.200 WAC. <br /> ��ai�.C�� +'Cl'll,l C v" � f - ���i " � � <br /> Signalure of OwnedContractodAuthonzed Agent Date <br />