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� _� . <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> /Z��G' j�����1�Q��P�ICATIONS ARE AGCEPTED FROM 8 AM TO 4 PM ��� ��-/(� <br /> SITE ADDRESS � TARCEL TAX I.D.# PERMIT I <br /> ' e a-I�-a.che i5 .r>���1 L>C'�D9G�/nv I �%l� -�O <br /> LEGA LOT NO. BLOCK TRAC70R SUBDIVISION# <br /> DESC. <br /> GWNER AODRESS CITYZP PHONE <br /> Se� a_-4-I-�-u-hed 1 i5� <br /> �onnmuni� lr��'N I��'$�Y�Y1FEF�l �e� �Qr. PHONEc�356-�1155 <br /> �' ' v e-Ma�TOe, br�n�Co hS- <br /> ��� -T--gD I it{v' rmai�io►� '��— °i� <br /> CONTR.UCENSE# W��� b�- Provid�cl a'�'�-FI�L Suces�'u► biclCJe�' {'125 �n <br /> de�.rmi�►ed <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �.(S - �w��� V f�-I'� _Electric _Gas_Other N/� 1 U� <br /> WORKDESCRIPTION �nS-�`I �o� �jR� jjY� �YL � �"rLl (j� VCI^C-f-� <br /> S.ee_ �L-�--f-u-�=h�c1. 9a'/. pla.v� �-e-� -�r �a.�r rev��ei.v <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TY'PE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireptace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Back(low preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof dreins Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this applicalion and know lhe same to be true and correct. All provisions of laws and <br /> ordinances governing lhis lype of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority ro violate or cancei the provision of any other state or local law regulating construction or lhe perfortnance of <br /> construction.That I am authorized by the uwner of this property lo per(orm the work for which applicai:cn is made and I comply with the <br /> Stata C�ntractbrs Law 1827 RCW and 296200 WAC. <br /> � 6' ZS' o <br /> Sign ure of wnedContrectodAuthonzed Agent Date I I� <br />