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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-6857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � Z �� �—a�p <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT# <br /> 5 l�7 . �� � � ° c� ra-oc 1 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITY/ZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PNONE <br /> CONTRACTOR NO�-'r•cI� �r� �/CP���iUY�DORFSS �GngO u CI IP PHONE <br /> Ni�ue1.�1-y Nrll �u( �.�t/mcnc� H?5 - �98-4111 <br /> CONTR.UCENSE p NOY 1�F�''O51 P�, Wrc, q8053 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Elactric Gas Olher <br /> WORK DESCRIPTION RPhCY�U �i 0i i C��� S r �n�(���- �1 Pc�c�f � �PI" �QfYI iyl�rPtiy <br /> �����" /../�S��1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Tollet A�'C-air handling unils <br /> Bathtub Forced air systems <br /> Lavalory�wash basin) _ Gas pipiny <br /> Shower Water healer <br /> Kilchen sink 8 dis{ios�l Gas lireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryor <br /> Wa�or healer Rangc�hood <br /> Sink(scrvice/6ar/moplcic.) Exhausl fan <br /> Backflow prevmrier Hea�pump <br /> Urinal Unit haatot <br /> Orinkinc�Founlain _ Boilar <br /> Floor drain _ Re(rigora�ion <br /> Greasc trap Woodstove <br /> Roof drains Other <br /> =I Olher_ ------ _— <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS 3105 <br /> I hereby ceritity Ihat I have read and examined Ihis application and know the same to be lrue and wrrecl All provisions oi laws and <br /> ordinaces governing ihis�ype of work will be cornplied wilh whether specified herein or not.The granting of a permit does not presume <br /> lo give authority to violale or cancel Ihe provision ol any other state or local law re,qulating construction or the pertortnance ol <br /> construclion. That I am aulhorized by lhe ownor ol fhis property to perlorm the work lor which application is made and I comply wilh the <br /> S�ate CaNraclors 18.27 RCW and 29G.200 WAC. <br /> / / <br /> �� � �o�- �� �--bl <br /> Sign lure of OwnadC actor/Aulhorized Agent Date <br />