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� PERMIT APPLIC�4TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STFtEET, EVERETf, i�NA 98201 <br /> 425-257-8810— F.4:t 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 RM <br /> SITE ADDRESS PARCEL TAX I.D.# PE IT# <br /> S/ O�i' EuE/z GRe e.✓W� — <br /> LECnL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER P,DDRcSS CITYIZF� pHONE <br /> TENANY NAM'c ; CONTACT FOR PERG7IT PHONE <br /> I� ��,-- v� - cE,��cn I SoH � v�b�:�� as�-yss-�s��- <br /> CONTRACTOR CD�S� To LcresT 3k� �IcrP���5 7S� E FN�✓S�a.,Q�N�ZIP PHONE <br /> CONTR.LICENSE# G✓����fp ,��C�� a�S��S�S <br /> C.ma.sT cao �3/'i 9 Ks. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> �i2-e � FFina.�e �13ovE �3�2o�rn5 <br /> PLUMBING MEGHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet _ A/C—air handling unils <br /> Salhtub Forced air syslems <br /> '�avalory(wash basin) Gas piping <br /> Shower Water hoaler <br /> Kitchen sink&disposal Gas tireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinkin� Fountain Noiler <br /> Floor drain Refrigerelion <br /> Grease lrep Woodstove <br /> Roof dralns Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX l"•OOE IS 3105 <br /> I here6y ceritify thal I have read and examined ihis application and know lhe sarr�e to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> to give zuthoriry to violate or cancel Iho provisien of any other state or local faw regulaling conslruclion or the performance of <br /> conslruction.That I am authorized by the owner of this property lo perform 1he work for which application is made and 1 comply with the <br /> Stale Conlractors aw 18.27 RCW and 296.200 WAC. <br /> � C� ��-w- /�- 9 -0 6 <br /> Sig tur o(OwnedConlrectodAuthorized Agent Dale <br />