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,- <br /> ; � <br /> 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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TG 4 PM / Z -6 �O b <br /> , SITE ADDRESS PARCEL TAX I.D.# PERMIT q <br /> aud, , 2 ��kf ,� ,� �� � ' /Z 3 <br /> L[GAL LOiNO. BLOCK TRACT <br /> D[SC. <br /> OWNER ADURESS CITYIZIP PHONE <br /> C.JPs7 �`G. � �3�a7£ � �U .� `i ICUc% : �✓; zt '� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �� <br /> �,,� _ -r s, � r f. t. -�;�'r;�,�: � ��scl ti.�5 7'fy �hS�� <br /> CONTRACTOR � � rI ��(,�NSADDRESS CITY2IP PHONE (,��, �,�y.GS� <br /> ����P£/LLJOo <br /> CONTR.LICENSEM 2 ��� ���' Y,>/ SI�� I_ J/J/7i-'JCJn� �(���3 �, <br /> A �J�2s � i, 7 ��s � <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> � <br /> L�fl'/(�r �l��Ct" _Electric _Gas_Olher ZPjg��� <br /> WORK DESCRIP710N <br /> ���s;�« „�'Ci�c��IGE �ti- � ��tRs a�t��n�ti�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TVPE OF FIXNRE OR ITEM <br /> _ Toilet NC—air handling unils I <br /> 6athtub Porced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> I = Kitchen sink&disposal Gas fireplace I <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Laundry lray Range hood <br /> Sink(service/badmopfetcJ Exhausl fan <br /> �ackflow preventer Heat pump <br /> Urinal Unit healer <br /> Urinking Pounlain 6oiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> �, I hereby ceriti(y Ihat 1 have read and examined this application and know the same to be true and correct All provisions of laws and <br /> I ordinar.es goveming this type of work wtll be complied with whe�her specified herein or nol. The granting of a permit dces not presume <br /> to grve authonty to violale or wncel ihe provision ol any olher state or local law rcyulating cons�ruclion or lhe pertormance of <br /> mnslruclion. That I am authorized by the owner of this property to perform lhe work for which applica6on is made and I comply with the <br /> Slate Con radors Law 1827 RCW nd 296200 WAC. <br /> / � { <br /> , l% i,c�. Ti�';-��1L ��tr(i, �� "�%; -(��� <br /> �� 9igna re of Owner/Conlraclod uthonzed Agenl Date <br /> I�� <br />