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; <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8t110-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T J 4 PM JD� a7�D <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �-532 �e�r-�o2e - �� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> ��p �+zi.�G�! z.s3z w1�-�-c FG��r�r 3�a -3�?--s�.s� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> D�''� �l��a,.� R ' <br /> CONTR.LICENSE# <br /> USE OF BUIL�ING HEAT SOURCE CONTRACT PRICE OF WORK <br /> O�( Cr,3 _tlectric _Gas_Other <br /> WORK DESCRIPTION <br /> jr�l � j�o�J <br /> PLUMBING MECHANI�AL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handiing units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <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(service/barlmop/etc.) _ Ezhaust(an <br /> Backflow preven�er _ Heat pump <br /> Urinal Unit heater <br /> Drinking Pountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> -- Olher <br /> CITY �r I�ERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certify Ihat I have read and examined � s application and know the same to be irue and correct. All provisions of laws and <br /> ordinances governing this t of work will be complied v:ith whether specified herein or not. The granting of a permit does not presume <br /> to give authority to violate o icel the provision of any other state or lucal law regulating construction or the performance o( <br /> construction. That I am authbriz d by the owner of this property to periorm lhe work for which application is made and I comply with ihe <br /> State Coniractors Law 18.2 R W and 296200 WAC. - <br /> " � �-"1 - t-o <br /> Signature (OwnedContrac or/Authorized Agent Date <br />