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P�tRMIT APPLICATICIN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 6 • I 6 �Q� <br /> SITE ADDRESS S — ��` PARCEL TAX I.D.q ER # <br /> ?oc?> t^l. C'/+5 �,^��, r �1 <br /> �D����,� <br /> LEGAL LOT NO. BLOCN TRACT OR SUBDIVISION p <br /> UESC. <br /> O�YNER ADDRESS CITY2IP PMONE <br /> (Z�� � �rl (� <br /> TENANT NAME CONTACT FOR PERMIT PHONE /, <br /> � (�FfrJC � � rF.��'I �'JC//1�K� l� E�hIAIL �I�� � LS %7 <br /> '�1ATRACTb� <br /> (l'�N-,1.� ►���,h�.�r'u cvr��i - <br /> CONTR.LICENSE M <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> (_. 4 (:� V✓ i� �� �' (C L �Eloclric _Gas_Othor �' DO Q nn <br /> I <br /> WORK DESCRIPTION <br /> �_� ;�;r.���_� cr� �� ��� ;,v�LrE<<_ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR IT[M NO. TYPE OF FIXTURE OR ITEM <br /> Toilet !JC-eir handling units <br /> Ba1hWb Forced air syslems <br /> Lnvalory(wash basin) Gas plping <br /> Shower W elor heator <br /> Kitchen sink 8 disposa� Gas fireplaco <br /> Dishwashcr Gas range <br /> Clolhes washer Clolhos dryer <br /> Wator healer Range hood <br /> Sink(servicc/badmoplolc.) Ezhaust fan <br /> Backllow provenlcr Heat pump <br /> Urinal Unil hoator <br /> Drinking Founlai� Boiler <br /> Floor drain Relric�eratiun <br /> Groaso trap Woodslr�ve <br /> Roof drains Other <br /> Olher — -- -- <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby coritify lhat I have read and examined this application and know lhe same lo be lrue and correct. All provisions ol laws and <br /> ordinaces e�overning Ihis type of work will be complied with whother spocifiod herein or not.The granting of a perrnil does nol prosume <br /> to g�vr. authorily lo violate or cancel Ihe provision ol any other slate or local law regulaling consWction or the pedormance ol <br /> construclion. That I am authorized by tho owner ol this propedy to perform Ihe work 1or which aDplicalion fs made and I comply with the <br /> Slal CoNractors Law 18. 7 RCW aqA 29fi200 WAC. <br /> �t".,�t� �� r,� .��� �. �t��/J/� <br /> ignatum c,f OwnedConlractor/Aulhorized Agenl Dat� �/L <br />