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PERMIT AP'PLICATIOI� <br /> CITY OF EVLRETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-25 i-8857—www.everettwa.org ' <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT# <br /> �'i � <br /> 1.�/�=: � ,`� � _ ��� -�.: � Cc:���- �-c o"�.� C��='� CllnZ�. — G <br /> LEGAL LOTNO. BLOCK TRACT \ <br /> DESC. � . � � � :�p� , J S I�CI�i <br /> OWNER AODRE55 CITY2IP PHONE <br /> _� ;AC�< �� ItC'� L(' � �� � 1 �I����✓. �,✓ f�UC ��1C �(�� ,`I��� :�� C'1.���'aSl•;;�<_ <br /> TENANTNAME , CONTACTFORPERMIT �PHONE <br /> L 1 �1 G-,,�►r�,�. � ' <br /> �`� '� � � C�n �'�x � � �)c��(; �_�I�: ��3� <br /> CONTRACTOR -�� �,�� �_ufL(. t_ ,,,, ,", AD�RESS CITYIZIP PHONE <br /> CONTR.LICENSE# ' n �. / <br /> C C� ,^� �r--� 7�: �-',-- _, % <br /> USE OF BUILDING I — HEAT SOURCE I C,ONTRACT PRICE OF WORK <br /> ��( F�r�,.-�'� <br /> Electric _Gas_Other 1�� ,�(;�� L: <br /> WORK DESCRIPTION <br /> �:�,�1(;,�i�v� `�� c�r.'�,� 1_� �i��c� :�- Y ��� i� x.�, � :,��� �;� k �;,� ;-�`?Uk „ �� l: <br /> ( A .1� _� �-��. ,.il��) . . . I� � l�[.W rl�l�tl.ln5 � 1��,,�p� TIO.-. �1� l'.0�.,' �l��l:'- 1 ( n�, '.�) <br /> I l l`A ,)'. ��;�'. 'I . � ; �' . �, , i. . C v 1 �1�4'�� �lF-�.' 1 ` <br /> PLUMBING MECHAP:ICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> BathWb Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace �� <br /> Dishwasher Gas range � <br /> _ Gothes washer Clolhes dryer ��I��� <br /> _ Laundry tray _ Range hood <br /> _ Sink(service/badmop/etc.) Exhaust fan � <br /> 8ackflow preventer Heat pump �y <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Oth=r <br /> CITY OF EVERET7 LO:.AL SALES TAX CODE IS 9105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces govzrnin�this type of work wiil be complied with whether specified herein or not The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property to perform!he work for which application is made and I comply with the <br /> State Contractor�w 1827 RCW and 296200 WAC. , <br /> %— � ���_ �/' �� l. y.��'' �' <br /> SignatUre of Owner/Contr r/ uthorized�� t Dale � <br /> __' I� <br />