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P�MIT APPLICATI�i <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org ��4�� -0o l <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE OT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# ��/ <br /> 3 as P d <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE Lf ,S- � <br /> Sflvr (��i c 1<S D � I� ��1C � I <br /> TE T NAME I CONTACT FOR PERMIT PHONE <br /> 'I v r�1.-v'� S �-�-��r ,�i 75 3-Z(n I- G'1��� <br /> CONTRACTOR %Il`L K�.I�1,� ��!'M • ��R p. gi�1C �(�.1 EYl Il-L.h'1 G��I.'!� �jb � �1�� <br /> CONTR.LICENSE# J q � Z Z <br /> 3-75 F� <br /> USE OF BUILOING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �,e ST�4r(,t,n } a-I � v�-_.,�1�- _Electric _Gas_Other <br /> WORK DESCRIPTION � <br /> PLUMBING MECHANICAL I <br /> N0. TYPE OF FIXTURE OR ITEM NU. TYPE OF FIXTURE OR ITEM II <br /> Toilet A/C—air handling units <br /> Bathlub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower � Waterheater <br /> � Kitchen sink 8 disposal Gas fireplace <br /> � Dishwasher _ Gas range <br /> Clothes washer , Clothes dryer <br /> Laundry tray y��W� Ranc�e hood <br /> � Sink(service/bar/mop/etc.)/: � �V� i�„�LS _ 6chaust fan <br /> = Backflow preventer � °i _ Heat pump <br /> Urinal � l �l�,� Unit heater <br /> _ Drinkin9 Fountaln . ��� Boller <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> iI hereby ceritity that I have read and examined this application and know tha same to be true and correct. All provisfons of laws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> � to give authonty to violate or cancei lhe provision of any othor state or local law regulating construcUon or the performance of <br /> ' construction.That I am authorized by the owner of this pn,perty to perform the work for which applicatlon is made and I comply with the <br /> IState Contractors L�18 7 CW and 296.200 WAC. <br /> � ��" � - � � <br /> j Signature of OwnedContractor/Auth ed Agent Date <br />