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PtRMIT APPLICATIC�IV <br /> CITY OF EVERETT PERMIT S�I�VICES <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �'"7d � ..=:'v�=,� Gcst�2 k.ta Y c+o 3i 3.Z-�`c' z - u r 3- �> / '�U�6(�3-OIS <br /> . <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# �f <br /> DESC. /J On ]� �.3CVL'_RG.v /�J�L.3 L71 ✓ / <br /> ON'NER ADDRESS CITY/ZIP PHONE <br /> /-/�.:=-.- i��, c L,/Y7C]Y—C y.c�s o�cwa�� t�. <�,,2=T:� �as-�s�-�-zy-�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE •f,;�S'- �SS–$ 3 s�' <br /> ts�7t.�.cc=r� <br /> f)-r�Yr�, /�7. �i �io�v %�- )�� �c'7✓icycT�I. �i��vio2� E•MAII��J/G`' � ��merrr`i�dl <br /> CO TRACTOR � ADDRESS CITYIZIP P ONE <br /> /-J �3 �A�l< l/-v•' n (jVC O.�?iNi: �'GG' Lf�`f -OlclS' <br /> CONTR.LICENSE# ����y �c�rv�w���r ��'~�"�� 3(« - G3 J • �Q� 1 <br /> R o�� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> --x� .3 S O o� C�O <br /> r��„�=-rs�, 5;�+-n-o JC Electric _Gas_Other I � <br /> WORK DESCRIPTION �,�„n <br /> �.� S�c <br /> �'C.i .Y�S �i SrLli�l�i ��•'•:� �V /') 7�a1 7C �5�. . G . <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling units <br /> Bathtub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clolhes washer _ Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Backflow prevenler _ Heat puma <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigera;ion <br /> Grease trap _ Woodstove <br /> Roof drains Olher _ <br /> �_ Olher Hu=�c �. ,> t� — <br /> ..,:..t�.. ��.0 _ <br /> � CITY OF EVERETT LACAL SALES TAX CODE IS 3105 <br /> I hereb�cerilify that I have read and exaroined this application and know lhe same to be We and correcL All provisions of laws and <br /> ordinaces governing this type of work will he complied wilh whelher specified herein or nol The granling of a permil does nol presume <br /> lo give autiiority to violale or cancel lhe provision of any other stale or local law regulatinc�construclion or the performance of <br /> conslruclion.Thal I am aulhorized by lhe owner of this property lo periorm lhe work for which application is made and I comply with the <br /> State Conlractcrs Law 18.27 RCW and 29G.200 WAC. <br /> � � ' � . /��%11 � ---�-_ %�2�/ � OS' <br /> Signa;areT—of DwnedConlraclor/Aul!iorized Agent Dale <br />