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,; ,:, <br /> PERMIT Q.PPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �' — 7 —O � <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED rROM 8 AM TO 4 i'M <br /> SITE ADDRESS PARCEL TAX I.D.# PER IT# <br /> � ��s-� <br /> . �.3 nm ��<d��Sf- <br /> LEGAI LOT NO. BIOCK TRACT OR SUBDIVISION# <br /> f:ESC. <br /> OWNER AODRESS �} CITY2IP PHONE <br /> ' VC� °�'�'"1 l lQ 161C)/',Sc�/'� ��,a' -�! /�O�i"�G/�(� �(�l'/l'�- <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR -�,��;i1���,!_ � AODRESS ( // � CITYIZIP PHONE 3GC.->'� 7-f�3 <br /> � b�_3 t?�a 'c<x�� y .� C�c<n�ui���J�. wA, jZ <br /> CONTR.LICENSEN C� J��',�,f /�?//�`�/' f]� �! //��\ t��JO� <br /> � � 6��� r� r�� li i �-/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �� ����U� G � <br /> ���� _Electric _Gas_Other �� <br /> WORK UESCRIPTION /�/� „[� /� I=�/�r/ �" �,!/ ('S �U� <br /> C1" {l.��v�/! ��l �i�-' /'� t :�` � �i'1 S Y u r � CJ <br /> � � / <br /> � ��� � �� , :.-�� G, �� ���� . �/w �G �� <br /> PLUMBIPJG MECHANICAL <br /> NO. Tl'PE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �_ Toilet __ A/C-air handling units <br /> BathWb Forced air syslems <br /> �I Lavatory(wash basin) Gas piping <br /> �I Shower � Water heater <br /> � Kilchen sink&disposal _ Gas firenlace <br /> Dishwasher Gasrange <br /> �! Clothes washer _ Clothes dryer <br /> Water healer Range hood <br /> Sink(serviceibar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> � _ Floor drein _ Refrigeralion <br /> � _ Grease trap _ Woodslove <br /> ` _ Roof dra�ns _ Other <br /> � Olher <br /> il <br /> CITY OF EVERETT LOCAL SALES TNC CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be lrue and currect. All provisions of laws and <br /> ordinaces goveming this type o(work will be complied wilh whether specified herein or noL The granting of a permit does not presume <br /> to give authority lo violale or cancel the provision of any ulher slate or local law regulating construction or the perforrnance of <br /> construction.That i am aulhorized by Ihe owner of this property lo perform the work for which application is made and I comply with the <br /> Stale C n c ors L ` 1827 RCW and 296200 WAC. <br /> ����� � � �� �J/ L/�� � <br /> Signature of O nedConl�todAuthorized Agent Dale � <br /> �— --- -- 1/J <br />