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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES , � <br /> 3200 CEDAR STREET, EVERETT,WA 98201 31��-�J <br /> 425-257-8810- FAX 425-257-8857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 A.M TO 4 PM <br /> SITE ADDRESS I�I I y •tvE'i{f�✓► PARCEL TAX I.D.y PERMIT N <br /> � u/�,. �l JlU 3- <br /> LEGA LOT NO. BLOCK TRACT .t�'EQ-�3_� / <br /> DESC. � <br /> OWNER , ADDRESS C�TY21P PHONE <br /> �/2�' � �ro Q,i ti�S !.� E� 7� / n.� +�✓E (z�) 2So•2�3 <br /> S "7 � r��,�, � �,� 9-r�;� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �h� �✓w I 7�ie- i JfCsl,lyE�c/ <br /> CONTRACTOR �r��(,F ��" NS ADDRESS �TY21P PHONE <br /> 2Go , ►�r E I Z �f �r 1 ,/' <br /> CONTR.LICENSE N S��Y����/ SD l�� �jy�-�y� GIJA.- //b�S� ��6, b S�� �0�4� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRAC�T PRICE OF WORK <br /> Electric Gas Other �!/� ���• <br /> ! <br /> WORK DESCRIPTION <br /> C�.� �� s���-- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> BathWb Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/moplelc.) Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> I hereby ceritify lhat 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 ot a pertnit doas not presume <br /> to give authority to violate or cancel lhe provision of any other state or local law regulating construcdon or the perfortnance of <br /> construction.That I am authorized by the owner of this property to pertorm the work for which applicatlon is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> - b <br /> Signatur of Owne ractorlAuthorized Agent Dat <br /> ��z <br />