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_a� .-o <br /> PEKMIT APPLICATION <br /> CfTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE i, 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 /> !- l," '�i L.�.�.>.��i, i�l � 1�.1dG t zC - ..3/��I�bl ��!'� � � �'� <br /> _LEGAL LOT NO. BLOCK TRACT <br /> OESC. <br /> l WNER ADDRESS CITY2IP PHONE <br /> C�'r'ic'��� l��/����� L��� 1:��� �,� n., `>c K,. � li. r. //1 `lbl ',./ ��/l� /�/ �i_�I'/6_ <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ��'r. ,i< t� 8,�jr�� �`�zS) �l8`i -s°�un <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> 1�15 � ff �i��� l��lcr � / lSG1 /�c�i}�,•/l %� '��.� A,'E � ilr,� <br /> CONTR.LICENSEM � (y2s� �br�.�yn-7 <br /> �n.s , r �i � ��ssR�, ;�: ,��. N c�q )kc�i <br /> USE OF BUILDING HEAT SOURCE CON7RACT PRICE OF WORK <br /> ,�r,, � � �14, �� y X EIoc1Ac _Gas__Othor <br /> WORK DESCRIPTION <br /> �`�� i ��[ . [ riii�l / < �� �CC.2 :-�(' �'�S �:' (�q-�. <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FI%TURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> ioilel A/C-air handling unils <br /> Bathtub Foiced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Show�r W aler heater <br /> Kilchr.n sink 8 dis�icsal _ Gas lireplaco <br /> Dishwasher _ Gasrango <br /> Clolhes washer Clolhes dryor <br /> Waler heater Range hood <br /> Sink (sorvice/badmoplelc.j _ Exhausl fan <br /> Backflow prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fou�lain 8oilor <br /> Fioor drain Re�rigoration <br /> Groase lrap _ Woodstovo <br /> Roof drains Other <br /> Olher <br /> CITV OF EVERETT LOCAL SALES TA)(CODE IS 3705 <br /> I herehy ceriti(y lhat I havo read and examined ihis application and know the same lo be lrue and correcL All provisions ol laws and <br /> crdinaces yoveming ihis lype of work will bo compliod with whe�her specified horein or nol.The grenling ol a perrnit does nol presume <br /> to give authority lo violata or cancel Ihe provision of any other slale or local law rec�ulating construclion or the perlormance o( <br /> construcGon.That I am aulhorized by the owner ol this property!o peAom�tho worl<lor which application is made and I complp with Ihe <br /> Slale Contractors Law 18.27 RCW and 296200 WAC. <br /> � � ,� t�� .� �- !4 <br /> (��2 ee r�� ��, J ° - <br /> Signature of OwnedCuniractodAuthonzed Ayent Da�o <br />