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�- i7 -o!o <br /> PERMIT APPLICATION <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PER IT# <br /> ZI I � Cal� z _ <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITY2IP PHONE�L� S�5 �IS� <br /> A�i� 4 v��i ` <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �lo N(z <br /> CONTRACTOR �� �L1� �,.��_� (µL AODRESS ��x �ZVyU CITY2IP PHONE <br /> � f-1 Z�'Z"�-`('77.5-C� <br /> CONTR.LICENSE t! '�Vr�J�U.���• <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORN <br /> (��1/L(AC^{i I _Eleclric _Gas_Other t N ,UGO �- <br /> WORK DESCRIPTION <br /> GoN ST2U=-Tc':1�J OF'- Zo�CZ`E� Wc�l=r� l`fZl�l4'� GfNw� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(NRE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhtub Forced air systems <br /> Lava�ory(wash basin) _ GaS,[�iping <br /> Shower _ ter heater <br /> = Kilchen sink isposal / _ Gas epiace <br /> Dishwasher _ Gas ra <br /> Clothes washer Cblhes dry <br /> Water heater Range hood <br /> Sink(service/�ar/mop/etc. _ Exhausl fan <br /> Backflow prevenler _ Heat pump <br /> Urinal / _ Unil healer <br /> _ Drinking Fourtl'ain _ Boiler <br /> Floordrain Re(rigera ' n <br /> Grease lrap _ Wood ve <br /> Roof drains �� <br /> Othor — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis appiication and know Ihe same lo be true and correct. All provisions ot laws and <br /> ordinaces c�overning this type of work will be complied wilh whether specified herein or noL The granting of a permit does nol presume <br /> to give authority lo violate or cancel the provision of any other slate or Iocai law regulaling construclion or the pertorman�e of <br /> construction.That 1 am aulhorized by the owner of Ihis propedy to perform the work for which application is made and I comply with lhe <br /> Stat tors I.aw 1�,�27 RCW and 296.200 WAC. <br /> �' 1 n�j/ /C ,l'..C-�o.�-� /-/?-UG� <br /> Signa ure of Owner/ onlractodAulhonzed Agent Dale <br />