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P�RMIT 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 B AM TO 4 PM L� `IL� .�� <br /> SITE ADDRESS � /� � PARCEL TAX I.O.# P RM)i# `7 r / <br /> Z G`3 OJ L7 Y //� � ,) l�"7 ' ��7 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION q � I, <br /> DESC. <br /> OWNER �N���,n� i��ADDRESS CITYlZIP P NEf <br /> SCo7/.�AL �� � 42 <br /> , z 70� C'Q�c���.30o yf2�/ 2.5z-S �vo <br /> TFNANTNAME tip,-n,pS CONTACTFORPERMIT PHONE y25 ' 737' �'J7S <br /> /� C�7.�//J���iJ �.J/�i0%/f/� /�( G-!S � � E-MAIL �`� '(� �/ <br /> �`$Rf��— D S I !ZI <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Qa�� � <br /> K _Eleclric _ Gas_Olher / � cJ C� <br /> � �- <br /> WORK DESCRIPT�ON <br /> / .1— �`7 �?� G� " � <br /> .� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handlinc�uni�s <br /> Bathlub Forced air systems <br /> Lavolory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/badmop/etc.) J Exhausl fan <br /> 8ackflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeraticn <br /> Grease Irap Woodstove <br /> Roof drains Olher <br /> _ Olher _ ' L� ..t�iNG <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify thal I have read and examined lhis application and know the same to be Uut�and corred. All provisions o(laws and <br /> ordinaces governing Ihis fype of work will be complied with�vhelher specified herein or not.The granting oi a permil does not presume <br /> lo give aulhority lo violale or cancel tho provision of any other siate or local law regulating construction or the periormance oi <br /> conslruclion.That I am authorized by the ow Pof this property to perform Ihe work tor which appliwtion is made and I comply with the <br /> Sta�le Nractors Law 19.�CW ancl 29 . �0 VJAC. <br /> ,C.�� ,. ' ,'�,p�/ > � f��� <br /> Sign2ture of OwnedContractor/Au zed AgeM � Dale I� <br /> Z <br />