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-------- -- -- —� <br /> PERMIT APPLICATION I <br /> CITY aF 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 � a — I 3— 1 C� <br /> PARCEL TAX I.D.# PERMIT# <br /> SITE ADDRESS I � �O/a2 'O�v <br /> =�� ISGor�1��-1r;�<k�C- <br /> LEGAL✓ LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> � <br /> C' q�+ ,/,,� �y f,• � X 1� io ��-���=rT�� ''tl- yz� `�'l�, ��2oa <br /> ���IVI'`7S'] (Ib�IiT�I PHONE <br /> TENANT NAME CONTACT FOR PERMIT <br /> E-MAIL <br /> CONTRACTOR A�DRESS CITYIZIP PHONE <br /> -%�il/�li�vj2 �'���: <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � �/���'� <br /> �f�����-�,�'G f�� _Eleclric _Gas_Other <br /> -f � �Yv <br /> WORK DESCRIPTION <br /> ����1��,`�G� �c%r'G�Di2cz �6ff�f'rTrilivc=t i�� :flc'�.--1-5 `��fEL'�`-�T�iF3� 13�Eiv <br /> ' p11iV�j <br /> � � MECHANICAL <br /> PLUMB►NG <br /> NO. TYPE OF FIXTURE OR ITEhI <br /> Np, TYPE OF FIXTURE OR ITEM <br /> Toilet _ NC—air handling unils <br /> Ba�htub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> -- Waler heater <br /> _ Shower Gas(ireplace <br /> _ Kitchen sink &disposal — Gas range <br /> _ Dishwasher Clolhes dryer <br /> ' � _ Clothes washer Range hood <br /> � _ Water heater Exhausl fan <br /> _ Sink (service/bar/mop/etc.) — Heat pump <br /> Backflo�v preventer Uril heater <br /> _ Urinal — goiler <br /> _ Drinkiny Feuntain Refrigeration <br /> _ Floor drain Woodslove <br /> Grease irap Other <br /> Roof drains -- <br /> Other — <br /> 1 i CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � I <br /> �� I hereby certify that I have read and examined lhis applicafion and know the same to be true and correcL All provisions of laws and <br /> i ordinances goveming this type of work will be complied wilh whether specified herein or not. The granting of a permit does nof presume <br /> � to give aulhority to violate or cancel the provision of any other slate or local law regulating consWclion or ihe performance of <br /> construclion.That I am authorized by the owner of this property to periorm the work for which application is made and I comply wilh the <br /> State Contiactore Law 18.2�RCW and 296.200 WAC. <br /> r ,�� /l�v� jb <br /> ,.__-�-_,� � �� -- <br /> SignaWre oL'OwnedContraclor'Authorized Agent Da� <br />