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PEI�IIAIT APPLICATION <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 S �� �` —0'J <br /> SITE AUDRESS PARCEL TAX I.D.# �RMIT# � <br /> , ��� � l <~ ,. - l ; � /� -' c. j[1j - /U <br /> LHGA LOT NO. BIOCK TRACT OR SUBDIVISION 9 �t Z� <br /> DESC. � 3��c-��Z'-{ZS <br /> 01VNER ADURESS CITY2IP PHONE <br /> ' --it- �f r:_� c�� c .— <br /> _ t\ r2 .,�L�:�\ C=:Z �LC!'ZCo:_ �J3C;�> (..�lC''�.rJ.i(.Y:67 /��=C_ � -L �'`G " ,l <br /> TENAN i NAME I CONTACT FOR PERMIT PHONE <br /> v�� �_. 1�.�..5 \C l' �-�.' <.v� <br /> CONTRACTOR �y�.�` .��� .; � ADDRESS CITY2IP PHONE <br /> � wc:�••nc�z.S �11�u \Sb••� S•.- Sc� <br /> CONTR.LICENSE il <br /> �L u.]i l S V;.� l..�b 1��1... <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � �� 1�,,��c� <br /> � -�-�� � �� � ��-���— " Electric _Gas_Other - , <br /> WORK DESCRIPTION �1 <br /> 1r�;-,1�. il � `>�c�.r� * c �.__, - t � 'ti�• c,..� '3�7r� L�..�� <br /> " r ._ ,..�Tc,r� ��-rtrc_ <br /> � ��:v�.r�-•�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet AIC-ai� handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> 1A'ater heater Range hood <br /> Sink(service/barimop(etc.) Exhaust fan <br /> Backllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof draii s Other <br /> Olher� �,�,� �:�� ;•, S; �_��. — <br /> — � � — <br /> C1 ) f'rtc'.' S�'�7,._..'7u�.-- S� i-r� <br /> CITY OF EVERETT LOCAI SALES TIV(CODE IS 7705 <br /> I hereby reritify that I have read and examined this applicatien and know the same lo ba true and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether speclfied herein or noL The granting of a pen*�il does nut presume <br /> to give authonty to violale or cancel the provision of any olher state or Iocai law regulating consWclion or the pedormance ot <br /> construction.That I am aulhorized by thP owner o(Ihis property to perform tho work for�vhich applir.alion is made and I ccmply with the <br /> State Conlractors Law 13.27 RCW and 29G.200 WAC. <br /> ` � � �`�- ��� ? <br /> Signature o(Owner/ContractodAuthorized Agent Date � <br />