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PErtMIT APP►�ICATION <br /> CITY OF EVERETT Pf�RMI't SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everetfwa.org ` .; ,� <br /> APPLICATIONS .4RE ACCEPTED FROM 8 AM TO 4 PM ��7��/�� � <br /> SITE ADDRESS PARCEL TAX I.D.it PERMIT# <br /> 3 r O 3 � a 8����`D� <br /> LEGAL LOTNO. BLOC TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PIfONE <br /> ro�l �-lai� S e� �a� S�n,�sz�- �c.b�� (�llev�� <br /> TENANT N E CONTACT FOR PERMIT PHONE <br /> 5 . �a� n /JGQ� 'Tr�� Z��`t���j� QOIh <br /> CONTRACTOR ��n J���,� IUJY{ I`�!� ADDRESS"]3L� r _ `, CITY2IP PHONE <br /> � � � � � z�6 3� �0?3 <br /> CONTR.LICENSE#Mq��uPN9y0 Q� �C1I9/OQ 'l�� <br /> �L /1 <br /> USE OF BUILDING Q��(/ r EAT SOURCE CONTRACT PRICE OF WORK <br /> ,(� w 5 �� <br /> ��� �` iKn r Jd�j _Eleclric �Gas_Other � <br /> „�� <br /> WORK DESCRIPTION <br /> / - l o����fi j "�-�` V �`5l'!�u�� �' �:�-i. �i �✓1 �- (,v <br /> 1 - � ��c��asy,�� Ra� ��� a�9�7� � r�^ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I7EM NO. IYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> � Shower _ Water heater <br /> � Kitchen sink&disposal _ Gas fireplace <br /> �_ Dishwasher _ Gas rangc <br /> Clothes washer _ Clolhes dryer <br /> � \Naler heater Range hood � <br /> _ Sink (service/bar/mop/etc.) � Exhausl fan <br /> Back9ow prevenler Heatpump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> _ Greaso trap Woodstovo <br /> . Roof drains _ Other I <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerilify lhal i have read and examined this application and know the same to bo Irue and corcect. All provisions of laws and <br /> ordinaces governing this type of work will bo complied with whother specified h�3roin or nol The grantin�of a permit does not presume I <br /> to give aulhoriry to violato or cancel the provision ot any olher slate or Iocal law regulating construction or the peAormance of <br /> conslruclion.Thal I am authonzed by tho owner ol:his property to perform ihe work for which application is maAa and I comply wilh the <br /> late Conlraclors Law 18.27 RCW and 29G200 WAC. � <br /> -� „ �/ •2(� 0% <br /> nature of OwnedConUactodAuthorized Agent Date <br />