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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �` ��6 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM � �OG]- �� <br /> i _ <br /> SITE ADDRESS � , _ LI PARCEL TAl(I.D.# PERMIT# <br /> �� /'1�—�:-- ' � �.i�! tf�� L"�•T — , <br /> LEGAL LOTNO. BLOCK TRACT ` <br /> DESC. � <br /> OWNER ADDRES§ CITY2IP PHONE <br /> �, <br /> � r •. i- �:;: �u�;}C. ��� ��'o� ZNUAV�. SCa�IG WA z��b dz59.2 6 <br /> TENP.NT.NAfdE CONTACT FOR Pf:RM1T PHONE <br /> �- �_ m-�� ,. 3 <br /> � 7., ,l � i jr:i �;.'i:. !1� "''j'G�wijO..S :" r h�"5=rf�� f��r, � Ly�� — � � � <br /> CONTRACTOR ADDRESS CITY2IP � PHOKE ,..,r�� <br /> t17� G'7Q�J�� �� ✓�.I <br /> CONTR.LICENSE N `�''� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r 1 � , � � , - _Electr.:: �Gas_Other � � 2 8 3 7. �� <br /> WORK DESCRIPTION ' �+ <br /> � � --1 , �`'":, ,._ i��,r.-� ,�� /„� '-�1" R �'�S: - SU � - �2-�o - ,vc <br /> I , .� .� '1�.'. _ ` < < -' ` '` "' - � <br /> I 7N1.��.i;-;�r� a 1 ����',vc� ��:�c� 1.�cc:,��1 <br /> PLUMBING MECH/iAICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR IiEM <br /> Toilet AIC-air handling units <br /> Balhlub Forced air syslems <br /> Lavatory(wash oasin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink (serviceNadmop/etc.) _ Exhaustian <br /> Backflow preventer _ He3lpump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease lrap _ Woodstove J <br /> Roo(drains Other •r'�.�P � N 0. v✓� <br /> Other ^ u� F', I�ord JS ��` <br /> CITY OF EVERCTT LOCAL SALES TAX CODE IS 5105 � <br /> I hereby cerilify Ihat I have read and examined lhis applica:ion ar.d know the same lo be lsue and correct. All provisions of laws and <br /> ordinaces goveming this lype o(work will be complied�.vilh whelher specified herein or not.The granling of a permit does not presume <br /> lo give authority to��iolate or cancel lhe provision of any other stale or local Iaw regulating conslruction or the perfermance of <br /> conslruction.That I am aulhorized by the owner of lhis property lo pertorm the work(or which application is made and I comply with the <br /> Stale Contractors Law 18.27 RCW and 296.200 WAC. <br /> Signature of OwnedConVactor/Authorized Agent Date <br /> �/Z <br />