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PE�MIT APPLICATION <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 a �a�•.p� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT iF <br /> � r �*e��n wU�� � bG9 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> S(sv'�✓�Y TY'�Y�` �a,� �'. 206 � 2� `r 52y5 <br /> CONTRACTOR OY',r-'e5q �i Y� 1�mTe��µ ADDRESS �I jy $' Lctc;I�S'� CITY2IP�'�y,J,./�PHONr L <br /> CONTR.LICENSE fl �.Yre 2����5 '9S�2 <br /> � F P94�' �- <br /> USE OF BUILD!NG I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas_Othar <br /> WORK DESCRIPTION � <br /> Ih S-�nlVf�� UL 30�. �i ✓'C SyS�{e�M Ti �2nNg �kod <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF POCTURE OR ITEM <br /> Toilet A/C—air handling units � <br /> Bathiub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal ` _ Gas fireplace <br /> Oishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/barlmop/etc.) _ Exhaust fan <br /> BackFlow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodslove <br /> Roof drains _ Other,�i� tr�pj�r�fllor ' <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that� have read and examined lhis applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not,The granting of a pertnit dr•es nol presume <br /> to give aulhority lo violale or cancel the provision of any other state or local�aw regulating construction or the perfom�ance of <br /> construclion.That I am aulhcrized by the owner of lhis property to perform the work for which application is made and I comply with the <br /> Slale Contreclors Law 18.27 RCW and 296.200 WAC. <br /> �'sY'�� ?• 16-0.1 <br /> SignaWre df OwnedContractor/Authorized Agent Date �i <br /> z <br />