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�CRMIT APPLI�ATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8&10— FAX 425-257-8857—www.everetlwa.org � `�—p 7 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM E OZC Z-G(S q� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT 1f <br /> r . �U`c_.-'- � P . � � �v0 � <br /> L GA LOTNO. LOCK TRACT .! <br /> DESC. <br /> ��rF/oS� <br /> OWNER ADDRESS CITY2IP PHONE �z�._yy.o <br /> t_.y��i�f'J�hs-1���To f � 2-� S )PY�r���d frr- oo .� o ^-0200 <br /> TENA NAME CONTACTFO-R�RMI7 PHONE � _._.�_ <br /> �U nn x rP✓�v�Ir � ��Yht'S' 4�G1 �� —b ?2 1 ��o <br /> CONTRA TOR C'n��d ADDRESS� CiTY21P PHONE <br /> 'f y S�"S' l37 i6 3iNo A,K- � Sc-a'a�-r� wA �l�- �6?t -�6 <br /> CONTR.LICENSE# �i7�DS T `7 Lf-�S _TT�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other �2���- <br /> i <br /> WORK DESCRIPTION <br /> -�n I�r:C�.-�� C��c+:,�v�1 L�+}�'s a�^ 1'rK��day <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX'NRE OR IiEM <br /> Toilet _ NC-air handling units <br /> Balhlub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kitchen sink&disposal _ Gas firepiace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Ciothes dryer <br /> Waler healer _ Range hood <br /> Sink(servicelbar/moplelc.) _ Exhaust fan <br /> BackFlow prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain _ Retrigeration <br /> Grease trap _ Woodslove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify that I have read and examined this application and know lhe 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 of a permit does not presume <br /> to give authoriry lo violate or cancei lhe provision of any other state or local law regulating consWction or the performance of <br /> construclion.Thal I am authorized by the owner of this property to perform the vrork for which applicatlon is made and I comply with the <br /> Stale Contractors Law 1827 RCW and 296.200 WAC. <br /> - _- ____ _ Z �2_��- <br /> SignaWre of OwnedContractorlAuthonzed Agent Date (� <br />