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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 B AM TO 4 PM <br /> SITE AUDRESS PARCEL TAX I.D.# P RMIT# <br /> � , ---� <br /> ��"�.�.�� ��Ti' >T. �a / );7� l 1'i� ' �� -_/ �'�� �� 7 � <br /> LEGAL LOTNO. BLOCK TRACT A1/ <br /> DESC. �� r� '�j � �_ ��^ ' I � � � �-i� Z�1 I ���� ;'�N �:IVIJ (i�ij'� <br /> OWNER pDDRESS � CIZYRIP PHONE <br /> -T���i� �1��,��,W,r '=',`�i � 1=.��,fiv"��w ��1P�, Fv��-�,H,WI� ���1����'h fu��)��: 1�?,'>; <br /> TENANTNAME I CONTACTPORPERMIT PHONE <br /> � X��.J� �'�VCJ.� � � � <br /> �'�� � " ; :��>l� N�ar,� I f�� i;I'1 �?=1 �- �I�.;t7:� <br /> CONTRACTOR �,' /��� ' � A) i/,. '/ ADDRESS CITY2IP PHONE _ _ <br /> V '1 �� : _ . -i.7 i� Q ro '� � � i or- -� . <br /> »� '�'� � }i„� .t,� 7,� � �. �'�� �t<.�� ��.�'1�-�� � j�J <br /> CONTR.LICENSEX I�G,���I�'�'.. : ���J�T'�.�I ." �� I n= � <br /> ' "J l�� � '' �/'1�1� '� /.��iil <br /> USE OF BUILDING /HEAT SOURCE ��� CONTRACT PRICE OF WORK <br /> �,.� � � Eleclnc Gas Olher ���I�) �)�,)J <br /> �'„ � ,Pc�r.inn�i,�;1�iDn ri�i����v — — — � <br /> WORK DESCRIPTION 1 � <br /> -�-,�.�����U��"i,��l U� � �t%1/\(�� f/�:�i.'jn/`%��� i �/ill�°�1��� �fif �,1��0�' !'�`�Qi/`���'7i ��'�� <br /> , � <br /> ��v;:�t���� �J� I'r,��1������'i,�u. <br /> PLUMBING ;,, MECHANICAL <br /> /���,'-\ <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C-airhandlingunits <br /> _ Balhtub Forcedatrsystems ,����� <br /> lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range huod <br /> _ Sink(service/badmop/etc.) Exhaust fan <br /> Backflow preoenter Heat pump <br /> Unnal Unit heater <br /> Drinking FounWin Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERLTT LOCAL SALES TA7(CODE IS 3105 <br /> II hereby centify that I have read and examined this application and know the same to be true and conect. All provisions of laws and <br /> crdinaces goveming this type of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision oF any other stale or local law regulating construction or the peKormance of <br /> consiruction.That I am aulhorized by the owner of this property to perfortn the work for which application is made and I comply wilh the <br /> Stale Can�rado Law 18.27 RCW and 296.200 WAC. <br /> ����1 � II � �IJi <br /> Signature of Own Contractor/Authonzed Agent � Date � <br />