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_ _ .. � _ ___ � <br />PERMIT APPLICATION <br />' CITY OF EVERETT PERMIT SERVICES <br />I 3200 CEDAR STREET, EVERETT, WA 98201 <br />; 425-257-8$10 - FAX 425-257-8857 - www.everettwa org <br />� SITE ADDRESS <br />__ _._.,� <br />LEGA OT NO. <br />� oEsc ( <br />OWNER <br />� 1� � I <br />� TENANT NAM� <br />� CONTRACTOR <br />� CONTR. LICENSE it <br />USE OF BUILOING <br />� W£)Rtt DESCRIPTION <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # PERMIT # <br />r--�-��- -_ _ _ _ _ _ �`�`��-��-������f�1�3 _ l - Ozs <br />_s <br />BLOCK TRACT OR SUB IVI ION �t <br />���',j�- C�-� �t ;Ic' , �C��s <br />AD ESS CITY2IP PHONE <br />• . <br />�,��� �� ��� v���� D�= �� ���� �,�����i��� �s����� <br />.., �j 7 <br />� .. t'1/ �� �7.J <br />;''� ' <br />.� -��� r �� e� <br />/. <br />PLUMBING <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />D�ink�ng Fcur.!ain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />CONTACT FOR PERMIT <br />:� <br />� � + � .. <br />t' . � + a i ' ,.. <br />PHONE � -��` � i'i P'�� 1�,;, C;� <br />.- Y J' <br />E-MAILr"r <-11.e f n� �c'�.n�,�:�..,t <br />HEAT SOURCE CONTRACT PRICE OF WORK <br />Electric _ Gas _ C3ther J�O� <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heai pump <br />Unit heater <br />��iA� <br />Re(rigeraiion <br />Woodsrove <br />C3iher <br />CITY OF EVERETT LOCAL SALES TAX CODE 15 3105 <br />I hereby certify that I have read and examined this application and k�ow the same to be true and correct. AIi provisions of laws and <br />nrdinances governing this type of work will be complied with whether specffied 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 thls property ro perform the work for �vhich applicat�on �s made and I comply with the <br />State Con ctors Law 18 27 RCW�nd 96.200 WAC <br />.` , <br />- � ✓ �/✓?�.0 - �.. <br />� <br />Si ature o Owne on ractor/Authorized Agent D te �� <br />. ; �/`Ji" / , L-�- <br />