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( <br /> PERMIT APPLICA�ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 3 ��� — O g <br /> 425-257-8810—FAX 425-257-8857—www.everelAAlpRrg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRF.SS PARCEL TAX I.�.A PERMIT X <br /> l ���R N`.. q`j Su��'1 �US'4�9��{U�2U � `- p �3"O� � <br /> LEGAL LOT NO. B�OCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2�P PNONE <br /> (�e���S tUa�l�ts�� l 3k2-s P��-Q,�,sW..�l �1�� �W��.ds l eG2G <br /> TEN{�+T NA CONTACT FOR PERMIT PHONE <br /> CktJG�C`5 ��tev ('�� �3�'ll Cy..� � 3Gc� • Y2�(-t�z5_' <br /> CONTRACTOR ��✓�r s�+r�� ADDRESS2/Q � �„YC�q���� PHONE <br /> � J o <br /> CONTR.LICENSEAYIA,e��-� /IU3 c7�� �UUk U-�IAUt.` 36042�1132� <br /> �'1 F� V <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> G�C s-��` q� _Electric _Gas_Other � � � U�� �—_ <br /> J <br /> WORK DESCRIPTION �e wU` � '� xi s !�� PU�� s C QL� <br /> r <br /> J <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ToiOt AIC-air han(�g units <br /> -alhtub Forced air systems <br /> i avatory(wash basin) _ Gas piping <br /> Shower _ t ater heater • �q <br /> _ h itchen sink C disposal __ Gas fireplace '/� <br /> aishwasher _ Gasrenge �a <br /> Clothes washer _ Clothes dryer \� � <br /> i aundry tray _ aange hood �� <br /> Sink(servicelbar/mop/elc.) _ Exhaust f2n <br /> -ack8ow preventer _ eeat pump <br /> � rinal �nit heater <br /> arinking Fountain _ -oiler <br /> Floordrain _ �efiigeration <br /> — Grease trep _ t oodstove I <br /> 0 oof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS 7105 <br /> I hereby ceritiry that I have read and examined this application and know lhe same to be true and correct. All provisiors of Iaws and <br /> ordinaces governing lhis type of work will be complied with whether�pecified lierein or not.The granting of a pertnit does not presume <br /> ta give authority to violate or cancel the provision of any other state or lowl Iaw regulating wnsWction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Conlractors i aw 18.2T o Ct and 296.200 i AC. <br /> c�,�.-t �� 3 — ����y <br /> Signature of O�NnedContrac or/Aut rized Agent aate i I <br /> L <br />