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I <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMlT 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 (("j—Q �j <br /> SITE ADORESS l01 `I I Zo 1 6 Q��••�' �� �e PARCEL TAX�.D.# PF,F�tMIT i{ <br /> � Y - l � <br /> Co•�)74Yico5'�o c4 �LJ . <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. -L� g L�, y2o <br /> OWNER ADDRESS CITYIZIP PHONE <br /> "�Q�.. V ��� tm�nn Zol (, groa�wa� /}-J� EVQ�ci�4�� 1�/� "z>-3i7- 9332 <br /> � 78k i • z�1 Y <br /> TENANT NAME � I CONTACT FOR PERMIT PHONE <br /> i� <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> /� / 1 <br /> CONiR.LICENSE# <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric _Gas_Other <br /> WORK DESCRIPTION <br /> 3p' �+ S' ceJ�r Eer� � n9 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I7EM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer _ Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil healer <br /> Dnnkin� Fountain _ 6oiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodslove <br /> Root drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhal I have read and examined this application and know the same lo be true and wrrect. AII provisions of laws and <br /> ordinaces c�oveming this lype of work will be complied with whelher specified herein or not.The grantinc�of a permit does not presume <br /> ro give authoriry lo violale or cancel the provision of any olher slate or local law rec�ulaling construction or the performance of <br /> construction.That I am aulhorized by lhe owner o(this property to perform the work for which applicalion is made and I comply with the <br /> Slale Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> • �� c�–V �– �I o 5'(zo e �, <br /> SignaWre of OwnedContractor/Aulhonzed Agent Date <br /> 1�Z <br />