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s g' <br /> �EF�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 3TREET, EVERETT, WA 98201 <br /> 425-757-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRON 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# ERMrIT#,/ <br /> a-��2' COZ6 AV� c��—. <br /> LEGA lOTNO. LOCK TRACT <br /> OESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> s�o��a L <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �lfS'{� �j2t�t�i � ���1'rt"f{ S-e.l�-Pit'1'lI� y7� ���j �u,���� <br /> CONTRACTOR��L.F(> ,Q�(�(/y�b (�G� ADDRESS CITY2IP PHONE <br /> � j �' 3 Z I 'T�E 5� �57= )�1em�ve <br /> CONTR.LICENSE# �va�t�p�-o33 c;�. ��11�{' g J?���� -1 l y CU�Z ' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � /�/ � , <br /> �CL4� � _Electric _Gas_Olher �U�� <br /> WORK DESCRIPTION ��'js'� �� ��w ��YD ���'� S���� <br /> � /2-.2 6�i Ccvc�l <br /> �'� -TY?Im �lu.;ndlvl� <br /> �� � -c�a1r� L>k7S`��r2j S��k <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITCM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Wafer healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryar <br /> Waler heater Range hood <br /> � Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Ffoor drain Refngeration <br /> _ Grease trap Woodstove <br /> Roof drains ',� Olher <br /> ✓ Other -(.�_� 6'�1<<F�'��' _ _ <br /> �X�.�� <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS]705 <br /> I hereby centify that I have read and ezamined this application and know lhe same to be We and currecL All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied with whelher specifed herein or nol The granting of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any other state or Iocal law regulaling construction or the performance of <br /> conslruction.That I am authorj�e�by the owner oi this properly lo periorm lhe work for which application is made and I wmply with the <br /> S)al Conlractors Law 18.27 f� W and 29fi200 WAC. <br /> ��- � �� �---- N—3 v h <br /> Si �ture o(OwnerlContractor/Aulhorized Agenl Date <br />