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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES p <br />3200 CEDAR STREET, EVERETT, WA 98201 / Z <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br />SITE ADDRElSS PARCEL TAX I.D, # PERMIT N <br />a taco Z. -P <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION 0 <br />DESC. <br />OWNER <br />�QVh�yy%%' 1km ADDRESS � S� CITY ZIP 1 U PHONE ��l'F" <br />jl \ - - <br />TENANT NAME CONTACT FORlPERMIT PHONE <br />E•MA14,lY�@-CAMWr'W�11.tF. <br />M. 't,0 to9�a s �o1�, s� K� , 6 A� CITY <br />a <br />CONTR. LICENSE 0 <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_L _ Electric Gas _ Other $ M <br />WORK DESCRIPTION 46, <br />1 //✓� 1 O�D.S OIGl <br />PLUMBING MECHANICAL I <br />NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br />Toilet AIC — air handling units <br />Bathtub _ Forced air systems A <br />Lavatory (wash basin) Gas piping I pA� J <br />_ Shower Water heater <br />_ Kitchen sink 8 disposal Gas fireplace <br />_ Dishwasher __ Gas range <br />_ Clothes washer Clothes dryer <br />_ Water heater _ Range hood <br />_ Sink (servicebar%mopietc l Exhaust tan <br />_ Backflow preventer _ Heat pump <br />_ Urinal Unit heater <br />Drinking Fountain Boiler <br />_ Floor drain Refrigeration <br />Grease trap — Woodstove <br />_ Rool drains Other_ <br />other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 0105 <br />1 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 governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />10 giv authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />con r coon. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />Statq <br />lit<VV w 18.27 RCand 296.200 WAC. <br />11 213 og <br />SignaU oltercontractorlAuthorized gent Date <br />Z <br />