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prRMIT APPLICATIUN <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 5�,,;�� PARCEL TAX I.D.# PERMIT# <br /> �IGZ ^ '.� '�Or� � � OS - 03 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> � OWNER ADDRESS � qTY21P PHONE <br /> So� �,�� ���1 r��, z� a;t �J� � � _ <br /> TENANT NAME CONTACT FOR PERMIT PNONE I <br /> CONTRACTOR ADDRESS CITV2IP PMONE <br /> q�Z y+�' S� � `IZS�R3�-Y371 <br /> CONTR.LICENSE# S���r �p ��I � `M IM`•'•'�a? 9gZ�.� <br /> \ � <br /> USE OP BUILDING HEAT SOURCE CONTRAC7'PRICE OF WORK <br /> �,,,r� _Electric _Gas_Other � �7 D 00 O <br /> i <br /> WORK DESCRIP'fION � . <br /> I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITENi NO. TVPE OF FIXTURE�R ITEM <br /> Toilet � _ A/C—air handling units <br /> Bathlub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> 3 Shower _ Waterheater <br /> � Kitchen sink&disposal _ Gas fireplace <br /> 1_ Dishwasher _ Gasrange , <br /> Cbthes washer Clothes dryer <br /> 1 W ater heater _ Range hood <br /> � Sink(service/badmop/etcJ _ Exhaust Nan <br /> Backflow preventer Heat purc�p <br /> Urinal � Unil heater <br /> �_ Drinking Fountafn � Boiler <br /> �_ Floor drain _ Refrigeration <br /> Grease trap __ Woodstove <br /> Roof drains _ �therA„_. <br /> Other — <br /> � � CITY OF EVERETT IOGAI.,SALES TA%CODE IS 3105 <br /> I hereby ceritifiy 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 eomplied with whether spec�ed herein or not.The granting of a partnR does not presume I <br /> to give authority to violate or cancel lhe provision of any other state or local law regulating construction or the perfortnance ot <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 1827 RCW and 296.200 WAC. <br /> 1�/1 �- � 1i-29-06— <br /> �7ljnature of Owner/ or.tracror/Authonzed Agent Date <br />