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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES Jz !�! ''�° <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.M PERMIT 1f <br /> 8 P � � lCoblz - ob(o <br /> LEG LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> z��8 Tt/�/ ��Z/.//�� I �atMc�s �1.�a1� �06 3s;3-9i�.3 <br /> CONTRACTOR [//� �� � AD�RESS CITY2IP �HOy�� �/y <br /> � � � �3niC SB53� , �� � <br /> CONTR.UCENSE k `I IS�I c� Q p¢ �/Q N T„�,�,,Q �/� <br /> � � �o��,t � � <br /> USE OF BUILnING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ElecMc Gas Other �p00, � <br /> WORK DESCRIPTION <br /> ��� '�^2 ����S�r b!'I �5�1, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water hea[er <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sinl:(service/badmoplelc.) Exhaust fan <br /> BackBow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> _ Grease trap Woodstove <br /> Roof drains Olher J Lp� <br /> _ Other _ �j`Ne Sy,�2}�SS,'JU .5yr7T <br /> r� <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritiry that I have read and examined this application and know the same lo be We and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied witii whether specfied herein or not.The grantlng of a pertnit does not presume <br /> to give aulhoriry to violate or cancel the provision of any other state or local�aw regulaUng construc8on or the perfortnance oi <br /> construction.That I am authorized by the owner of this property to perform the work for which applicatlon is made and I comply with the <br /> Stat ractors Law 18.27 W and 296.200 WAC. <br /> ` d - � o <br /> Si a Owner onlr todAutho ' e Agent ate <br /> y2 <br />