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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-www.everettwa.org <br /> APPLICATIOkS ARE ACCEPTED FROM d AM TO 4 PM 6-a 6-c� <br /> SITE ADDRESS PARCEL TAX I.D.N PE,RMIT t <br /> 3 0 o b� (�v� 00�15� -c� -oa�-p \ ' i , C) , � <br /> IEGA LOTNO. BLOCK TRACT ' <br /> DESC. I Z C.J <br /> i <br /> OWNER ADDRESS CITY/LP��y�3 PHONE <br /> _L.��`� �hE(L 1�t�z E� r-����J� L,��t.��� �1 E� o Re �l. �126-4?3-�6lCXi <br /> TENANTNAME CONTACTFOR PERMIT pHONE <br /> I�EQ�-� �`iEEZ��'. <-4z5-3'��-1115 <br /> CONTRACTOR��� ��l��y,rL��,�,� ADDRE55 CITY2IP PHONE <br /> -7'iOYI <br /> CONTR.UCENSE# .� "t11 <br /> ���LPti��. 0�1�3'� 3c�1� �\\ � Si- , �.v���lT <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> -Y���l�ct�-- �Electric Gas Other L�C��� <br /> WORK DESCRIPTION <br /> �57�hw1� sh��y�F-���. z'.12 n��r;��mu�:� S��p <br /> �E-��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IiEM NO. TYPE OF FlXTURE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Batlriub Forced air systems <br /> _ Lavatory(wasb basin) l'+as piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fiieplace <br /> _ Dishwasher Gas range <br /> _ Clothes�.vasher qothes dryer <br /> Laundry tray Rangehood <br /> Sink(servicelbarlmopletc.) Exhaust 7an <br /> _ Backflow prevenler Heat pump <br /> Urinal Unit healer <br /> Dnniting Fountain Baile� <br /> _ Floor drain Rehigeration <br /> G�ease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT IOCAL SALES TA7C CODE IS 3105 <br /> I hereby ceritity that I have read and examined this application and know ihe same to be true and wrtect All provisions of laws and <br /> ordinaces goveming Uiis type of work will be complied with whetl�er specified herein or not.The granting of a permit does not presume <br /> to give autfionty to violnte or cancel tlie pwvision of any other state or bcal law regvlating construction or the peAormance of <br /> construction.That I em authorized by the owner oF ttiis property to perform the wnrk for which application is made and I comply with the <br /> State Contractors Lew 18.27 RCW and 296200 WAC. <br /> �J�_�!� � c�12� ��� <br /> $ignature of er ontrac o ed Agent Date <br />