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PERMIT APPLICATIO�V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERFTT, WA 98201 <br /> 425-257-8810- FAX 425-257-8057 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � Z�b ' / <br /> SITE ADDRESS Cs '� PARCEL TAX I.D.# PERMIT# <br /> �� .,, � w I.� - r�0 <br /> LEGAL LOT NO. 8L:CK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> /}�ro��� AI�'1 � r �a. 2c_SH— aCxo-33�l -�37 <br /> TENANT Nl�ME y I� <br /> CONTACT FOR PERMIT �� �1MPJR[.�hPHONE <br /> '�M ZFj�/V� �N� /v�l�L�l.�C- 'K�a►G'�,�y�f-t t�( R�'� `�-�Y E•MAIL <br /> CONTRACTOR ADDRESS CITY/cIN rnv <br /> (�t--KlKt� H� �ccG �7 n�, <br /> 5�« ��- i� 1 <br /> CONTR.LICFNSE# Q q� _ <br /> �� � CONTRACT PRICE OF WORK <br /> USE OF BUILDING HEAT SOURCE <br /> /f� � w <br /> �r�� I _Electric _Gas_Other��� `�jL� • <br /> WORK DESCRIPTION `���� ' U� lT � �� � G�� � \�C <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> fvG-air handling unils <br /> _ Toilet — Forced air syslems <br /> _ Bathtub Gas piping <br /> Lavalory (wash basin) Waler healer <br /> _ Shower Gas fireplace <br /> Kitchen sinic&disposal — Gas range <br /> _ Dishwasher Clothes dryer <br /> _ Ciolhes washer Range hood <br /> _ Walerheatar Exhaustfan <br /> _ Sink(service/bar/mop/elcJ — Heal pump <br /> _ Back(low preventer �/ Unit heater <br /> Urinal — goiler <br /> _ Drinking Founlain Refrigeration <br /> Floor drain Woodstove <br /> Grease trap '— p�her <br /> � Roof drains — <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES'fAX CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined lhis application and know the same to be lrue and correcL All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or noL The granting of a permit does nol presume <br /> to give authoriry lo violale or cancel the provision of any olher state or local law regulaling conslniction or lhe performance of <br /> construclion.That I ar authorized by the own�r of this property to perform ihe work for which application is made and I comply with the <br /> Stale Contractors Law 18.27 RCW and 296.200 WAC. <br /> � � )�a ��i ti�l'�� �� �d— � "0� <br /> Sig�'at�rero(pwner/Co r2ctodAuthonze 9enl ) Dale <br />