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P�RMIT APPLICATION <br /> �CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET. EVERETT, WA 96201 <br /> 425-257-8610— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED s-ROM e AM TO 4 PM <br /> SITE ADDRCSS PARCEL TAX I.D.N PERMIT N <br /> ;� 2 ,� I `g l Ol v- v�3 <br /> LEGA LOT NO. BL CK TRACT OR SUBDIVIS:'1N A' <br /> DESC. <br /> OWNER ADDRESS CITYI2IP PHONE <br /> �rA�y v�- /nA-�'���� �i�sr 3ioY T �� � vc �� - �- � � <br /> TENANT AME CONTACTFORPERMIT PHONE f/��_������/3� <br /> ��� �" AY/V L /\C�GS L� � I�����T���S/ �� E-MAIL�j'i I�TA7l L/'tf0/I I� � <br /> CONTRA <br /> 01��t ��2 <br /> CONTR.IICENSE# <br /> USF OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��'r�,7-L _Electric _Gas_Other '���8 (� <br /> WORKDESCRIPTION C,. ..� S�� <br /> � � FU <br /> �vn� ��� �r�% � — c�1��y-c � c�.s e <br /> , � 01 � 1'�°R M• G�ft n° /i, � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. � TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Dathtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas firep�ace <br /> Dishwasher Gasrange <br /> Clothes washer . Clothes dryer <br /> Water healer Range hood <br /> Sink (seivice/badmop/elc.) Ezhaust fan <br /> Dackflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain �oiler <br /> Floor drain Fetrigeration <br /> Grease irap Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriify that I have read and examined this application and know the same to be true and correct. Ail provisions oi laws and <br /> ordinances governinq ihis rype of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authonty to vinlate or cancel ihe provisio�of any olher slale or local law regulating construclion or the periormance of <br /> construction. That I ain authorized by the owner of this property lo perform the work tor which application is made and I wmply with the <br /> Slate Coniractors Lavr 18.27 R�CW��and 29G2D0 WAC. <br /> � � �2. ��Tl�.�-I� ���� �/d <br /> Sio a re o wnedCohiractor/Authorized Agent Date <br /> ��T <br />