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PtRIlIIIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICAT!ONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE A����� ���0����� PARCEL 7AX I.D.tl PERMIT il <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> TENANT NAME / CONTACT FOR PERMIT PHONE <br /> -"� ._ �/ v� ���7 ���9�V �� ��-�`-.32���-.��¢ <br /> CONTF?ACTOR �L C2�7�/1,�C4f".� ADDCR-ESS :j�1 - i��Zy/�-,C�TYlZIP PHONE l/�.�_�2n.•�� <br /> ,u r / / <br /> CONTR.LICENSE N //���/� �U-L� L/J ��y/" , ,!n �1/L, <br /> �� �7 n s � ���� ,s-�- � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK � <br /> � <br /> �� 7� ��� _Electric !'�Gas_Ofher ��L)��C� � <br /> WORK DESCRIPTION � " <br /> ��.�5'Ti9C� �J ��r- �/� �AS' ���'��i �� <br /> � G C��/l�f /�N� /JC/CT//�I� CC�(I <br /> PLUM ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel y� A/C–air handling units <br /> �/� BathWb Forced air systems <br /> Lavalory(wa.=h basin) �� Gas piping �j ' <br /> � Shower � Walerheater <br /> ' � Kitchen sink 8 disposal � Gas fireplace <br /> � Dishwasher � Gas range <br /> Clothes washer Clothes dryer <br /> Z Water heater• O Range h�od <br /> j�� Exhauslfan <br /> Sink(service/bar/mop/elc.) i <br /> Y Backflow prevenler _ Heat pump <br /> � Urinal = Unit heater <br /> Drinking Fountain Ploiler <br /> Floor drain Relric�eralion <br /> Grease trap Woodstove <br /> Rooi drains Oiher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 3705 <br /> I hereby cerili(y lhat I have read and examined Ihis application and know the same to be We and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whelher specified herein or nol.The�ranting of a pennit does nol presume <br /> to give aulhority fo violate or cancel ihe provision of any olher slale or local law regulatiny construclion or the performance of <br /> construclion. That I am authorized by lhe owner of this property to perform the work for�vhich 3pplication is made and I comply with lhe <br /> State Coniractors Law 18.27 RCW_ang296200 WAC. <br /> .�.�.`��/ , <br /> ��v <br /> Signature of OwnedContractor/Authorized Agenl �i ala <br /> 1_ — — -- <br />