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– —� ` —� <br /> PERMIT APPLICATION <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 /> � APP�ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N PQI�tM1T N � <br /> 0 2soyz 2o c � l�Ci3 G�5 <br /> LEGAL LOTNO. BLOCK TRACT <br /> oEs�. 2 -n.,e c+e -cor � B �' � P�� <br /> OWNER ADDRESS CITY2IP VNONE <br /> C��n� y`��2 20� ST � Z�r� r�� �z�, c2s3� 4i�3oo3 <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> �� IAh�,<<c Y�rr.zxlc yzT s8S- /007 <br /> CO RACTOR � ADDRESS PHASE W�lrio161Nd PNONE <br /> �// �Ol�s� P/��6.� . z�a�r�oNofau.cirvRoassz <br /> CONTR.LICENSE M � REUMOND,WA 98053-8376 1 g$ _�oa <br /> RL _Pt�►os io ent� (y � 3 7 <br /> USE OF BUILDING HEAT SOURCE I C�TRACT PRICE OF WORK <br /> fI '-/e �o`S � �Electnc �Gas_Other /U,,pOO � <br /> w�^ <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FU(TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handiing units <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) Gas piping <br /> Shower � Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> � Sink(service/badmop/etc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> �- Urinal � Unit heater <br /> �� Drinking Fountain Boiler <br /> � Floordrain � Refnge�ation <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL$ALES 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 viol2te or cancel the provision of any other state or local law regulating construction or the performance af <br /> construction.That I am authorized by the owner of tfiis property to peRorm ihe work for which application is made and I comply with the <br /> Stale Contractors Law 1827 RCW and 296200 WAC. <br /> A� P '1��--�C 3 -Za-o� <br /> S�atur Own Contractor/Autborized Agent ate <br /> � <br />