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PERMIT APPLICATI&I <br /> CITY OF EVERETT PERMIT SERVICES <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 /> 2 Z 3 Well- E,Ae cS >� :"'�' 1 'c�—C7ti 1 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. '7 9. <br /> OWNER ADDRESS CITY/ZIP PHONEY,2_C 351 <br /> �3 yy <br /> bc P (A.o 3 3 we_cf f,oer-4 Sc . io/v P.rf o <br /> TENANT NAME CONTACT FOR PERMIT PHONE 1/44-.1 yg-739 y no <br /> (3l i til•p r � C �Wl 4( E-MAIL ‘1/ 1)4 /AI tbF�GN44( lioCO w� <br /> CONTRACTOR ;,r V 4m S�rVCY/p�� ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# * R 1. O Lig <br /> g Al 1, .S6 0 -) 70 a,#-/y <br /> USE OF BUILDING Y HEAT SOURCE CONTRACT PRICE OF WORK <br /> 72V-Itrit9k(Ct Electric Gas_Otherd: 3@' -s <br /> WORK DESCRIPTION rtiv.0 A <br /> PLUMBING MECHANICAL. <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 1-1c Toilet NC—air handling units <br /> 1 X Bathtub Forced air systems <br /> 1 )C Lavatory(wash basin) Gas piping <br /> Shower ` or Water heater <br /> / X Kitchen sink&disposal Gas fireplace <br /> / k Dishwasher Gas range <br /> / x Clothes washer % Clothes dryer <br /> dl► Water heater 1 Range hood <br /> / Sink(service/bar/mop/etc.) Ar Exhaust fan <br /> Backflow preventer v Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I 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 /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.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 /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Si ture of Owner/Contr for/Authorized Agent Date \I <br />