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. � � <br /> PERMIT APpLICATION <br /> CITY UF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 3��� 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLlCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT R CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS C 5!A�/v�/� PARCEL TAX I.D.# P RMIT N <br /> � 1 a �ENr��z I �K�9-oy � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> 1�1��L// ��cv.ti4s Z 7. 7 ,�<.ff����e/�'�,E iF►-�-�. �_Y LS� r/Z L L/O <br /> T NANTNAMC CONTACTFORPERMIT <br /> �j -Jr�iLO/ PHONE <br /> c.!'vizn/Ol �Szirrl /�/Jri/Fcrs zS3 fjo�1 � '37 <br /> CONTRACiOR AODRESS CITYRIP PHONE <br /> CONTR.LICENSE X <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 5✓�io1Nd!✓iGr� SifP�I�' I _Eledric ,�Gas_,Other I �.J^�D� <br /> WORK DESCRIPTION <br /> � �w�1rv?` //�/JiuvrinrT- Gv�zn�d5 S�ds.dw.��iu�4� Sn�cY� <br /> PWMBING MECHANICAL <br /> NO. TYpE OF F�XTURE OF.ITEM N0. NPE OF FI%TURE OR ITEM <br /> _ Toilet _ A/C—airhandlin units <br /> _ Bavatory(wash basin) _ Forced air systems <br /> Shower _ Gas piping <br /> _ Kitchen sink 8 disposal _ Water heater <br /> Dishwasher _ Gas fireplace <br /> Clothes washer _. Gas range <br /> _ Laundry irey _ Clothes dryer <br /> _ Sink(service/bar/mop/etc.) _ Range hood <br /> BackFlowpreventer _ Exhausttan <br /> Urinal _ Heat pump <br /> Drinking Fountain _ Unit heater <br /> Floordrein _ Aoiler <br /> _ Grease trap _ Refrigeration <br /> Roofdrains _ Woodstove <br /> Other _ ONer <br /> CITY OF EVEREiT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and ezamined this appliwtion and know the same to be We and correct. All provisions of iaws and <br /> ordinaces goveming this type of work will be complied with whether spedfied herein or nol The granting of a pertnit does not presume <br /> i• to give authority to violate or cancel the provision of any other state or local law regulating construdion or the periormance of <br /> construction.That I am authorized by the owner of this property ta periorm the work for which application is made and I c�mpty with the <br /> State Contractors Law 78.27 RCW and 296200 WAC. <br /> iSignature of Owner/Contractor/Authonzed Agent Date � <br /> ' .5�� , / <br /> � <br />