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�� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -wuvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /p-�7—/(' <br /> SITE ADDRESS �/ PARCEL TAX I.O.# PERMIT IF <br /> l �i�,$� �vcr crn (o/'� � D/D - 7D <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TENANT N E CONTACT FOR PERMIT PHONE aj'3_��g- G�i Z.O <br /> �� ����— I �(�Cw �cA't� E-MAIL <br /> LcBFIfILSb R B//_wa-g r,:r C.n{r� ( A DR � P Sl 7 <br /> / is,s s c��i« s� -r�,.��, sfry�c �s3-3 3- 7i$ <br /> CONTR.LICENSE#qIl WF�f�Co�y( Z <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE DF WORK <br /> Electric LC Gas_Other �/ Z o 0 0 <br /> ��.�„«�;. I - rl�� N« ,�< < - <br /> WORK DESCRIPTION � � <br /> %entn� Tn.P�.ccn.�n f � 0 L/��r-���� ^ �Gr 0 � �cc G � <br /> i� •r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhlub 3 Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Cblhes washer _ Clothes dryer <br /> Water healer _ Range hood <br /> Sink(service/badmop/elc.) Exhaust tan <br /> Backtlow preventer _ Heat pump <br /> Urinal ,_. Unit heater <br /> Drinking Fountain ,_, Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap ,_ Woodstove <br /> Roof drains _ Other u C <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3795 <br /> I hereby certify that I have read and examined this application and know lhe same to be lrue and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel lhe provision of any other stale or local taw regulating construdion or the performance of <br /> construction.That I am authorized by the owner of this property lo perform the work for which application is made and I comply with the <br /> State Contractors Law 18.27 CW and 296.200 WAC. <br /> _ _"/ - <br /> . � Date <br /> Signature ,rier/C ntractor/Authorized Agent <br />