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P�RMIT APPLICATIG�� <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 ACCtPTEO FROM 8 AM TO 4 PM 8,�(� .�> <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT i� <br /> �8/y Co�b f}ve �ue� 70�- l <br /> LEGAL LOT O. BLOCK TRACT OR SUBDIVISION ri <br /> DESC. <br /> OWNER ADORESS CITYfZIP PHONE <br /> ��M (� Z8/y �/6y ��2 �ve-R.f�� 9YZo/ <br /> TENANTNAME / /CONT�A/CTFOR PER 1T PHONE �zSJ �y y - 6l7Z � <br /> ��✓��Wh I�Q.h(, (/�LZG���liLci � {-�0�� E�MAILV�.�h✓e�]'W�;TJ"1/uf( <br /> � CbNTRACf R 6��5 I I H <br /> S(i1L'� �G< G���,7 � <br /> CONTR.LICE E <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _Electric �Gas_Other <br /> WORKDESCRIPTION �dQ/�y�g � hp�y 6�1Seooti. , �y�WP1Q.f <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> .3 Toilet !VC-air handling unils <br /> Bathtub Forced air system; <br /> � Lavatory(wash basin) Gas piping <br /> � Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> � Waler heater Range hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhal l have read and examined this application and know the same to be true and correcl. All provisions of laws and <br /> ordinaces goveming Ihis type o(work�ti�ill be complied wilh wh�ther specified herein or nol.The granting of a permit does not presume <br /> lo give authority lo viol�te or cancel the provision of any other slale or local law regulating construction or the performance of <br /> con=_truclion.That I am authori�ed by the owner of this property to periorm ihe work for w�hich application is made and I comply wilh lhe <br /> Stale Conlractors Law 18.27 RCW and 296.200 WAC. <br /> Signature of OwnedContractodAuthorized Agent Dale <br />