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. � � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMI? SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ^_�:I��' " _� ] <br /> 425-257-8810-FAX 425-257-8857 -www.everettwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS �LL=9� �•J'� ��� PARCEL TAl(I.D.# P�RMI�# )/� <br /> Iv'So0 ���� J <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER/ � ADDRESS CITY2IP PHONE <br /> ��;rl�iUr r'� �)-� ' ��C'C�J�V'-�C�4��Lt�� rf�,L% J --- <br /> TE—�N� ' I 'CONTACT FOR PERx�f PHONE <br /> �E�w�►vA�vcc Niss�N �JoH�✓ �IA�S�N ��25 25l i800 <br /> CONTRACTOR�IN�E1Z IND�STRIG�`i '�DURESS CITY2IP PHONE <br /> I(�435 OLYn1P�cAvES 'r�Kwl� y2g_yg�-lj�c� <br /> CONTR.LICENSEA` 7�/,/I����/�Q� �� IZ'�� 'O�� /UIS(/ � <br /> IY\ /v <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��ry�����A L _Electric _Gas_Olher � _1�� ��� <br /> WORK DESCRIPTION <br /> iti5-�Ru- ��) ��✓� w�r�� , �lo" r� , 30" S�cpa�8an�� w�7N �j��-f�cs <br /> - PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ AIC—airhandlingunits <br /> Bathtub _ Forced air systems <br /> Lavafory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Laundrytrey __ Range hood <br /> Sink(service/barlmoplelc.) _ Exhaust fan <br /> BackOow preventer __ Heal pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ 9oiler <br /> Floor drain _ Refriga�3tion <br /> Grease trap _ Woodstove <br /> Roofdrains Other , <br /> Other — <br /> CIN OF EVERETT LOCAL SALES SAX CODE IS 3706 <br /> I hereby ceritify that I have read and examined this application and know the same to be lrue and correct. All provisions ot laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or nol.The granling of a permit does nol presume <br /> to give authority to violate or cancel the provision of any other stale or local law regula'ing construdion or the perfortnance oi <br /> construction.That I am authorized by the owner of lhis property to perform lhe wark tor which application is made and I comply wilh lhe <br /> State C tractors Law 1827 RCW and 296.200 VVAC. <br /> �(��,�/�� ,� �An /O'2l'0� <br /> S� atur o Owner7Co r/Authorize Agent Dale �L <br />