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— — � <br /> PCRMIT APPLICATIt,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 5 ' �8—� 7 <br /> SITE ADDRESS � PARCEL TAl( I.D.p PERMIT N <br /> 51� w • �n5,we Fa. � j�0705 OG S� <br /> DESCL LOTNO. � BLOCY. TRACT _ <br /> OWNE-R ADDRESS CITY/ZIP PHONE <br /> ���:�i� S��NGu Zns- ii� 5� ti�E NIa�Cys��;uc wn9rz�� 3s< b;q.a)Ps <br /> TENANT NAME CONTACT FOR PERMIT PHOHE <br /> L Au�� 's y,,,,� ,a�. N <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �;?� ����� F4�,g;.,c <br /> CONTR.LICENSE It <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �4+y SAL.�N _Electric __G,�s_o�r��� 3 yoo,tr. <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE UR I1CM <br /> Tollel A/C-a�r handling units <br /> �alhlub Forcad air sysloms <br /> � Lavalory(wash hasir) _ Gas plping <br /> Shower Watoi heatcr <br /> Kitchon sink 8 disposal _ Gas fireplace <br /> Disliwasher Gas rango <br /> Clolhes washor Cblhes drycr <br /> � Water hsater _ Rango hood <br /> Sink(s�rvicelbaumopletc.) _ Exhausl fan <br /> Backflow proventr.r __ Heal pump <br /> Urinal Unil hoator <br /> Drinkin�Fountain _ Boller <br /> /� Floor drain _ Refrigaration <br /> Groas�trap Woadslove <br /> Roo(drains Other <br /> Olhor _ <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I heroby ceritify that I hava reaA and oxaminn,d this application and know the same to be true end conecL All provlsions o(laws and <br /> ordinaa,s goveminc�Ihis type of work will be complied with whether speci(ied herein or noL The grenling ol a permit does not presume <br /> to qivo�uthority to violato or canr,el Ihe provision ol any other stale or local law regulating constructlon or the parformance of <br /> construclion. That I am aulhorized by tha ownar ol this proporty lo peAorm Uie work for which application is made and I comply with the <br /> Stale Conlryac�lors Law,(18.27 RCW and 29G.200 WAC. <br /> /5�4..��� r/b'/�� <br /> Signature ol Own IContractor/Aulhorized Agent Date <br />