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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /D �-/3-06 <br /> SITE ADDRE/S'S /� � PARCEL TAX I,D.N PERMIT M <br /> `,SU�� > I�JIw itc� �Ui✓1b— � '1- ) <br /> LEGAL LOT N0. BLOCK TRACi OR SUBDIVISIOfI M <br /> DESC. L'GI� <br /> OWNER ADDRES9 CITY2IP PHONE <br /> � � <br /> TENANT NAME �I—a CONTACT FOR PERMIT PHONE <br /> 7'v P I. I c,�., �..: I 14 4�f 7 I Ca�i�'c��.e•/�C- �.'u�a� <br /> 7L <br /> CONTR.LICENSEMTUn�I� �-f- � �13 N � ��In���' 4'''4 � Z�t'° -`�4( -9�13 <br /> � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ZS�>d <br /> � p S��c✓� $hGC ��- _Elactric _Gas_Other � <br /> WORK DESCRIPTION <br /> I hs ��� �l vvJ �p0� �... I'P�l— �/-�� OGc'7� �L �y� �rv+� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A1C-air handling units <br /> Ba1hWb Forced alr syslems <br /> Lavalory(wash basin) _ Gas p�{�ing <br /> Showar Waler healer <br /> Kitchon sink&disposal _ Gas(ireplace <br /> Dishwashor Gasrange <br /> Clothos washcr Cblhos dryer <br /> Water heater Rango hoad <br /> Sink(servico/bar/mop/otc.) _ Ezhaust tan <br /> Backflow proventor _ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiter <br /> Floor drain Relrigeralion <br /> Graaso Irap _ Woodstove <br /> Roof drains Other _ <br /> Olhor <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS J70S <br /> I horeby coritify that I have read and examinod lhis application and knaw the same to be lrue and cortect. All provlsions o(laws and <br /> ordinaces yoverning this type of work will be complied with whelher specified herein or nol.The granting o(a permit does nol presume <br /> lo give aulhority lo violate or cancel tha provision ol any olher stale or local law rogulating wnslruclion or the peAortnance of <br /> construction.That I am authorized by lho owner of this propeAy to perfarm lhe work for which application Is made and I wmply wilh lhe <br /> Slato Conlractors Law 10.27 RCW and 296.200 WAC. <br /> Signalure ol OwnedContractodAuthorized Agent Dale , <br /> �" <br />