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� ,� <br /> > <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 88201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SIT�ADDRESS PARCEL TAX I.D.M PERMIT N <br /> ii =L� � � t -1i- MCL11 ��'n� S[ ; �,3y�c9c �, ��r.acC � � ,�,��Z� <br /> LEGAI LOT NO. BLOCK � TRACT <br /> DESC. � -� 3 0 c,o o cr ��-L�c�ct�WR � C rZ s1- <br /> OWNER ADDRES$ CITY/LP PHONE <br /> (' K (�ri��k r i-ie s �x;� ��J�°S1 t�IC��n dt � (����,�m �U1� `���01 <br /> TENARTNAME CONTACTFORPERMIT PHONE <br /> l CVe � � I�C1c kn�{t- I �li�c� �.1C�coh� .���3 1�2�- �44-1L <br /> CONTRACTOR ADDRESS CITY2IP PHONE t' <br /> A�i,C, ,cc��, ►J�c�, ��,� ��co23�-►t, A�-eci �,� ts����-�� c�2 ;�4{� � <br /> CONTR.LICENSE� y�� `1-�� <br /> �NtLI?INIC�'�`LI7C� LXp lr ( Z�r ��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ,._ — I � ���5n� � fi�t ._ Irc� <br /> ��C � C�L � Elednc Gas Other <br /> — — '�: -.�.;��:�'.._ <br /> WORKDESCRIPTION �<'1hC�C � XfSIIY1CI SIC1�15 . I4l<�tll� j�1(��VI(.� LIA� l�\��� �Uil�y <br /> (' �1Q6� L�C t �( �-{Gt S � J <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 renge <br /> Clolhes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbarlmop/etc.) Exhaust fan <br /> Badcflow preventer Heat pump <br /> Urinel Unit healer <br /> Drinking Fountain Boiler <br /> Floordrain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT IOCAL 9ALE3 TAX CODE IS 3706 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and corred. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether spadfied herein or not.The granting of a pertnit dces not presume <br /> lo give authority to violete or cancei the provision of any olher state or Iocai law regulating construction or the perfortnance of <br /> construction.That I am authorized by the owner of this property to perfortn the work for which applicalion is made and I comply with the <br /> State G�ontradors Law 18.27 RC�N�and 296.200 WAC. <br /> , llt �;t 4it t: r t ��� � I n� <br /> Signatu2 c 10wneri ontractodAuthonze Agent Date <br /> % <br />