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.� <br /> N�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA98201 , . :, j� �� �- c- �•�c� <br /> 425-257-8810— FAX 425-257-0857 —www.everettwa.org r� <br /> APPLICATIONS ARE ACCEPTED FRUM 8 AM TO 4 PM <br /> SITE ADDRESS , <br /> PARCEL TAX I.D.# PERMIT li <br /> � �/C� ��i�orj�=� ��°� i1Y L.i;.;j� � a'-0 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADURESS CITYIZIP PHONE <br /> i <br /> ?ENANT NAME n� CONTACT FOR PERMIT E�HONE <br /> �/ � � l" . �. '.� - .�G'/�/ <br /> ( �C� �»l�� �.�% � d��.��� I >��J `- '�- <br /> CONTRACTOR �S 'JI`��l ADDRESS (i?��3 I 3:��'�'� ��TY2�P! PHONE <br /> .�Lt:ti=� �,..� id •,� ; �✓G.� .�C�i �n <br /> �� �i'. li�': i)i �:��} I . <br /> CONTR.IICENSEp I �/�JS� jG�� ' �cj;l_, �,.�„ <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas_Olher <br /> ��(� / ��� i � <br /> WORK DESCRIPTION ''�� <br /> i- ���l� rJ i �t' j " <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 1 Toilel _ A/C-air handling units <br /> Bathtub _ Forced air syslems <br /> y Lavalory(wash basin) _ Gas pipinq <br /> Shower _ Water heater <br /> f Kitchen sin!;8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clolhes dryer <br /> f Waler healer _ Range hood <br /> Sink(servicelbadmop/elc.) _ Exhausl tan <br /> t3ackflow prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> I Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woodslove <br /> Roof drains _ Olher <br /> Olher — - <br /> CIIY OF EVERETT LOCAL SALES TA%CODE IS 9105 <br /> I hereby ceriti(y Ihal I have read and examined this application and know lhe same to be true and wrrect. All provisions of laws and <br /> ordinaces c�oveming lhis lype of work will be comp�ied with whelher specified herein or noL Tho granling o(a permit does nol presume <br /> to give authoriry lo violate or cancel lhe provision of any other slate or local law regulating construcfion or lhe performan�e of <br /> construclion.Thal I am authorized by the owner of Ihis property lo periorm the work for which application is made and I wmply wilh the <br /> Sla o Contractors Law 18.27 RCW and 296200\NAC. <br /> � � — <br /> � �� .', ,�2%�,y .� _�`r <br /> $igd ture of O vnedConlractodAuthonzed Agent Date <br /> '� J <br /> i — <br />