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P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8610—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM d AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D./ PERMIT/ <br /> � �- , L o 2 o Iy � ayy 8'� <br /> LEGA lOTNO. BLOCK TRACT <br /> DESC. �L�OS G G <br /> NER ADDRESS CITY2IP PN <br /> 7ENANT NAME I CONTACT FOR PERMIT PHONE 2y 5. p g C�` <br /> �V.2VAD02 �i�CLc:.( A �'Wk1ba2 G�� c.C_/4 C?06 � � <br /> CONiRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE 11 <br /> USE OF BUILDING I — HEAT SOURCE ,� I CONTRACT PWCE OF WORK <br /> Electric Gas Other z�V U QO�^ <br /> WORK DESCRIPTION <br /> w� �a� R�����-� p ��� W��. 1 vt �row� O �=7�� � �c�c� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waterheater , <br /> Kitchen sink 8 disposal _ Gas fireplace . <br /> Dishwasher Gasrange <br /> Clothes washer _ Cbthes dryer <br /> Water heater Range hood <br /> Sink(servi;.�e/badmop/elc.) _ Exhaustfan <br /> Backflow preventer _ Heat pump <br /> Urinai Unil healer <br /> Drinking Founlain _ Boiler <br /> Floor drein Retrigeration <br /> Grease lrap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby ceritify lhal I have read and examined this application and know lhe same lo be true and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specified herein or nol.The granting of a pertnit does not presume <br /> to give aulhority to violale or cancel lhe provision of any olher slale or local law regulatlng construcUon or the perfortnance of <br /> construction.That I a authorized by the owner ot ihis property to perform the work for which application is made and I comply with the <br /> State Conlractor 18.27 RCW and 296.200 WAC. <br /> , / ..= 5-26- � <br /> SignaWre of wne I�ontractodAuthorized Agent Date <br /> �_"� <br />