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P�cRMIT APPLICATI�N <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 8 AM TO 4 PM 3_ �7� <br /> ��tre C <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � �! ���:1.�-'� I ' l <br /> %G�3.��� L✓rv ✓:n /h�" �M/" � - <br /> LEGAL L6T NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �//I '�'i•/�G� � / >O /L��� <br /> TENAHTNAME CON7ACTFORPERMIT NHONe�,�._ 3Sy- �Sz3 7 <br /> 7�»'1 �n _���l✓/Lc / �i:l�/� � �v��fS IL� EaY1PJL <br /> CbNTR �fiR D6�§ ITY P HON <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��.�z,,v� �(���c _Electric y Gas_Other <br /> WORK DESCRIPTION <br /> aG�GIGL�'y JiGInI�Lin ��• �-+'�ezeY ' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A!C-air handling units <br /> Balhtub Forced air systems <br /> La�atory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas(ireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> BackFlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain �G Refrigeralion <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this app�icalion and know lhe same to be lrue and correct. All provisions of taws and <br /> ordinaces governing lhis type oF work will be complied with whelher specified herein or not.The granting of a permil does nol prosume <br /> to give aulhority to violate or cancei the provision o(any other stale or�ocal Iaw regulaling construclion or the performance of <br /> consduction. That I 2m authorized b/lhe owner o(lhis property lo perform the work fr,;whlci� application is made and I comply with the <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> �?- C3 -/7 - `�`� - <br /> SignaWr of Ow Centractor/Aulhonzed Agent Date <br />