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—— l . <br /> PERMIT p►PPLICATION <br /> CITY OF EVERETT PERMIT SERV�CES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810 - FAX 425-257-8857-www.everett�Na.ors <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �_ �J <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT# <br /> " oo W , �-�S/N� -o3D <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> UESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �jnt�ll�✓C.� <br /> TENANT NAME C NTACT FOR PERMIT PHONE <br /> �OtS '•'`�<>• ��f�1Px�2Sk/ y e.nini��G -2r9Y <br /> ���L�,L�-nl <br /> CONTR.UCEN�E N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��'�,�/ s l/E,L 1��� I _Eleclric _Gas_Ulhcr ' � s�11C�lC <br /> WORK DESCRIPTION <br /> /2�Lvc/17C� 3� oG � ' <br /> P�UMBING MECHANICAL ' <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C-air handling units <br /> Bathlub __. Forced air sy;lems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Water hoater <br /> Kitchen sink 8 dispos�l _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Water healer _ Range hood <br /> Sink(servicelbadmou/etc.) _ Exhaust lan <br /> Backflow prevenler _ Hoal pump <br /> Urinal _ Unil healer <br /> Drinking Founlain _ Boller <br /> � Floordrain Woodstoven <br /> Grease trap <br /> i _ Rool drains = Olher <br /> Othar <br /> ' CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I�II heroby cerilify that I have read and ezamined Ihis applicalion and know lhe same lo be lnie and correct. All previsions ol laws and <br /> . ordinaces governing this typo of work will be complied wilh whelher specifiod herein or not.The grentiog ol a permit does nol presume <br /> Ito yive aulhorily to violale or cancol lhe provision ol any olher stalo or local law regulaling consUuc�ion or ihe perlormance oi <br /> Iconslruction. That I am authorized by the owner of this propaAy lo pertorm Ihe work lor which applicalion is made and I comply wilh ihe <br /> State Conlractors Law 18.27 RCW aqd 296200 WAC. <br /> � ��� ��n,.,,� �� , ia��'3 �d <br /> ignature ol OwnedContractorlAu�horized Agont Date �/ <br /> I- -------- _ . ___ -- � <br />