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„.,... <br /> i._-.r:. . <br /> ; � -:�•� <br /> �� . <br /> P MIT APPLICATI <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 /> .. �v ,� ,�,1 ` �- � -�” ') �' - -�� <br /> 1C i � y`+�, <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> � �IF. �. . ' / . <br /> ����'���,;��i�` � �� � c rl� `��� �-, �,����� �_ ��, ��`C� l_�� � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ` \� 1, � E—MAIL <br /> CONTRACTOIj, , ADDRESS CITY/ZIP PHONE <br /> �, , / <br /> �...J�i •G'�.� V <br /> CONTR. LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Electric Gas Other � � � � <br /> � ' t � -.--� — — ,� �-- � <br /> .�'' ' � tL <br /> --=--r---' '=� <br /> WORK DESCRIPTION _ <br /> ,�, .-. �'� � 1 � ��. _ , " - ,�� ''_- - `�� <br /> ^ �)�l.:�...t.�'; .. � ti.i�..�.i� �'� `� 'v`` � <br /> 'L��� � �''� � � '� 1 <br /> /_���Gi�r�� ���� '/ ,� � ����. <br /> _ ` ,-�'��,-(' 1�.C:�.'\�� '" : `;��,i� ,� . ,\ ��,r • �r,hi` '�; , `�c'\�� �^ � t <br /> `.,�` ��i��� . . . <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 /> Backfiow 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 ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces 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 Contractors J�aw 18 27 RCW and 296.200 WAC. <br /> p i, ^--- �� � -�� �- r- (%� <br /> J ( <br /> Sig r o Own 7Contractor/Authorize Agent Date <br />