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P�tRMIT APQLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-6810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N �RM -�/_ Q</ <br /> I g r u; 5 �/"' <br /> LEGA LOT N B CK TRACT OR SUBDIVISION N � � ('no!��qS <br /> DESC. "7 � Pv <br /> OWNER ADDRESS CITY2IP PHONE <br /> 7ENANTNAME CONTACTFORPERMIT PHONE <br /> wA ,qa+cF <br /> �AI�I C� ��6 I�i � ST' IEU� � ��lf�a� �( �z�&' .G43y <br /> CONTR.LICENSE#�bYAI.�IU°�I�F�{�t <br /> USE OFBUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas_Olher Lp ���-�J <br /> WORK DESCRIPTION <br /> :v,,-4'�,,,Q� r '�,�1 n..l'�I ��-�-�-✓ . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM NO. TYPE OF FUCTURE OR ITEM <br /> Toilet A/C–air handiing units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <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 Fountain Boiler <br /> Floor drain RefrigeraUon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> lo give authority to violate or cancel the provision of any olher state or local law regulating constructlon or the performance of <br /> construction.That I am authorized by the owner of this property to pertorm the work for which application is made and I comply with the <br /> Stale�ontraclors Law 18.27 RCW and 296.200 WAC. <br /> ��n,. .� t'�I • WC'� <br /> Sig ature of OwnedContraclorlAus orize gent D le - 1/Z <br />