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P�RMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES , ��,�I� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 '• ' <br /> 425-257-861 U-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.� P�� <br /> � `S � <br /> LE LOT NO. BL K TRACT <br /> DESC. <br /> OWNER r �� , w� ADDRESS r^ CITY2IP PNONE <br /> AJ•� �25 � fW.N.�1� .�Jvn ' �I�aGR�Y.tIQ <br /> TEN�AME �� .� I�_� I CONTACT FOR PERMIT �3—Q73-�",�v� <br /> �� <br /> as �Kon �_ �.��f�-6 <br /> CON7RACTOR , . � le/� /� _��.0._ �� ADDRESS CITY2IP PHON�� <br /> 11" y �r� �� �2.s1� r��- l 6 3rds�" <br /> CONTR.LICENSE N <br /> V���LvIDy�D 9mpr J:I� p r �7z �1�— <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Y Other ��v" - t <br /> WOR DESCRIPTION�^� ' ��`� �' �C �� n�� <br /> v�� <br /> � fn � P� � R-�f'�.� <br /> PLUMBI MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FUCTURE OR ITEM <br /> 'Z� Toilel _ A/C-afr handling units <br /> Bathtub Forced afr systems <br /> � avatory(wash basin) T Gas piping <br /> ower Water heater <br /> � Kit en sink&disposal Gas fireplace <br /> _ Dish �sher � as range <br /> Clothesyv asher C es dryer <br /> � Waler he'ater � Ran hood <br /> Sink(servic ar/mop/elc.) y_ Exhau fan <br /> 1_ Backflow prev ter Heatpu <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> _ Roof drains � Other <br /> Other <br /> — �, � . <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritiry that I have read and examined this application and know the same to be true and cotrect. All provisbns of laws and <br /> ordinaces goveming this type of work will be complied wilh whelher specified hereln or not.The graMing of a permil does not presume <br /> to give aulhority to violate or cancel the provision of any other stale or local law regulating construcffon or the peAormance of <br /> construction.That I am authorized by lhe owner oi this property to pertorm the work for Ich applicadon is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WA . <br /> � �Z�� <br /> Signature of OwneriContractor A orized Agent Date <br /> ��2 <br />