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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 42r257-8810— FAX 425-257-8857—www.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � PERMIT N <br /> SITE ADDRESS PARCEL TAX I.D.N - <br /> 3 � 6 � � (�(FUC -OC� ., <br /> —CGS <br /> LEGAL LOTNO BLOCK TRACT <br /> DESC �'� CITYIZIP PHONE <br /> OWNER ADDRESS <br /> 1-�OP �v�� rl'��,�.� , 0 �ox �7n7 w��iF �5�.�1��1�:'�`/ <br /> TENANT—� NpM�- � <br /> CONTACT FOR PERMIT PHONE <br /> � 7�$3 _ � '���c �� —— <br /> �� w` GTYILP PHONE <br /> CONTRACTO ` ADDRESS � 7GY�f�/ ` ^ e �_ / ' ��.^ /�G73� �., 7 h's��' /t <br /> �C_C–D ��"IYP�� ��N�S� �S� /v �f(/ �vu�t %.��. <br /> CONTR.LICENSE M <br /> f7�L��5/ �y�/�h �( — <br /> USE OF BUILDINO <br /> HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ( �—_,Electric _Gas_Other 3(%G'Lb��JL <br /> CN�,n ) `�� l7C/`C <br /> WORK DESCRIPTION <br /> �� ,� ��1��� �, <br /> , ,�„��� .�> -��r � <br /> �� ------ MECHANICAL <br /> PLUMBING <br /> Np. TYPE OF FII(NRE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> — — " AIC–air handling units <br /> ToAet – Forced air systems <br /> Bathtub � Gas piping <br /> �_ Lavatory(wash basin) -- Waler healer <br /> _ Shower Gas fueplace <br /> _ Kdchen sink 8 disposal Gas range <br /> Dishwasher Clo�hes dryer <br /> _ Clothes washer '— �ange hood <br /> Laundrytray Exhaustfan <br /> � � Sink(semcePoar/mople�c � Heal pump <br /> _ BackBow prevenler — UNt healer <br /> Unnal — Aoiler <br /> _ Dnnkmg Fountain — {�etrigeration <br /> Floor drain — y�roodstove <br /> Greasetrap Other <br /> Roof drains " � — <br /> � Other __111 — <br /> __. .__ __- --- - - -- --- .. <br /> . ..-- - -- - .____. .. - - <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 7106 <br /> I hereby cenUly that I have read and examined this application and know the same to be true and correcl All prowsions ol laws and <br /> orAinaces govermng�his type ol work wdl be complied wdh vAiether specdied herem or nol The granhng ol a permd does no�presume <br /> to grve authordy to violate or cancel lhe provision of any other state or local law regulalmg construdwn or the performance ol <br /> conslruction That I am authonzed by the owner of lhis property to perform the work lor which application is made and I comply�+nth the <br /> State Contractors Law 18 27 RCW and 296 200 WAC <br /> Signature of Oa+nedCon�rectodAuthorized Agent Dete <br />