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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES I� <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 ' `� ,A� <br /> SITE ADDRESS PARCEL TAX I.D.il PERM # � <br /> iFo� Ca�� ��'���, � o/ - t;�,<, <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �Itik'}� v�� %.'YL.LC� U i�c�j �L�LiiS' h'L't. �G!.^J, 'i��S ��5 i.LS.3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> NTRACTOR A RES I / IP H E <br /> i;��cty ��,��%:U"cTic;J i �j�t/ :�1�' RUc. /%�SV,_ '�Sw�E 3C�..c.?z.�Z> > <br /> CONTR.LICENSE# <br /> ��;��i�y� o � ��.; <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> < � Eiectric _Gas Other <br /> �� �". , — — <br /> WORK DESCRIPTION <br /> /�E — �Qo�,,<'irJa �k/Si i,v�� �C'��� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> Todel A/C—air handling unils <br /> Balhlub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> S"�ower Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Ciothes washer C�othes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Greaso trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TNC CODE IS 3105 <br /> I hereby ceritify lhal I have read and examined lhis applicalion and know the same to be true and correct. All provisions of laws and <br /> nrdinaces goveming lhis lype of work will be complied with wheiher specified herein or nol.The granting of a permit does nol presume <br /> to give aulhority to violate or cancel the provision of any othrr slalo or local law regulating conslruction or liio per!ormance of <br /> conslruclion.That I am aulhorized by lho owner of Ihis property to perform the work for which applicalion is made and I comply with tho <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC <br /> ' /. <br /> ` ���, , ��; � � i�3 /� � <br /> Signature oll0wnedContra odAuthcri�ed Agen: D� <br />