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PLRMi'� APPLICATI(.�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR �TREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-uwvw.everettwa.org <br /> APPLICATIONS R.RE ACCEPTFD FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADUR�SS P,�RCEL TAX I,D.# PERMITI <br /> O �,,, D <br /> LEGAL LOTNO. BLOCK TRAC�f <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��} cel� iSio.� /� 7or cuc.r�r�c..� 6.c� f. �Gi�c-C� � <br /> TEkANTNAME I CON ACTFORPERMI PHONE <br /> r'7«�er M A�vice �u'�o MGfiur _ �GuG ]�Lo�l, �fZS- �7(,-$�g33^ <br /> CONTRACTOR ��rr c0 �DRESS CITY2IP PHONE <br /> �r Nc�v 7yoo Ni�-s�,., rJ (��p. <br /> CONTR.LICENSE N �'t��� n6�a D 3� <br /> &crryNco 77���. rCv[.v�(� (,� �7�fZo� <br /> USE OF BUIL�ING HEAT SOURGE CONTRACT PRICE OF WORK <br /> Electric Gas Other ,� Z 9�J0, �� <br /> C4r r�J�-,� � — — — / <br /> WORK DESCRIPTION . <br /> inJs,�tLc Cl s�,n, ct5%,�x�� •,. cK,s��:;,� �o[c s�v <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF F�XTURE OR ITEM <br /> Toilet A�C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washar Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiier <br /> Floor drain Refrigeration <br /> Grease trap Woodstuve <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereoy ceritify that I have read and examined this applicalion and know the same to be true and corred. All provislons of laws and <br /> ordinaces governing this type of work will be complied wilh whelher specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law reguladng wnstrucGon or the porfortnance of <br /> construction.That I am aulh rized by tye�vner of this property lo perform the work for which appllcatlon is made and I comply with the <br /> State Contractors Law 1 RC /. 00 WAC. <br /> G '�(- <br /> Signature of ner,Contractor/Authcrized Agent Date �� <br />