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P�tRMIT APPLICATI�nI � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.* PERMR/ I <br /> / 2 C� , d� zF � � O <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION S <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHJNE <br /> O . 9v�P � %�/u � ZO� —��� —�2 Z <br /> NANTN ' � CONTACT FOR FERMiT PHONE [�T^?�,�o c�2 <br /> ��'-S � <br /> D� '=�1��e�t��J.,orr T����— E�N� �,c�.��s e�T�a i <br /> �i-'�P�y S��S /9��6 (-��� 99 �k4- (�rH wo�d c�r 27�-a � 92 <br /> CONTR.LICENSE il / <br /> S�� ��rT� � `�- I v <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICF OF WORK <br /> _ElecMc _Gas_Other ���j9 <br /> WORK DESCRIPTION <br /> �-f-a V �����( 1�44�-s 6-►� l-� � � I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXiURE OR ITEM NO. TYPE OF FU(T11RE OR 17EM <br /> Toilet A/C—air handling units <br /> Bathtub Forced alr systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Watar heater <br /> Kitchen sink 8 disposal _ Gas ftreplace <br /> Dishwasher Gas range <br /> Clothes washer Cbthes dryer <br /> Water heater Range hood <br /> Sink(servicelbar/mop/etc.) _ E#iaustfan <br /> Backflow preventer _ Heat pump <br /> Urinal Unk heater <br /> Drinking Fountain _ Boiler <br /> Floor drain RefigeraUon <br /> Grease trap _ Woodstove <br /> Roof drains Olher _ <br /> Other <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and know the same to be 6�ue and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specNied herein or not.The grenting of a permit does not prt�sume <br /> to give aulhority to violate or cancel the p:ovision of any other state or local law regulating consWcdon or the performance of <br /> conslruction.That I am aulhorized by the owner o(this property lo perform the work for whlch applicatlon is made and I comply with the <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> 4.��`�'-�5�_ �.''�'�� q <br /> Signature o ractodAuthonzed Agent Date \�2 ` <br />