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( t <br /> PERIlAIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FA:C 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 5� - 30 - l7 7 <br /> SITE ADDRESS . r/` f �";I,'Y/I�\t.C�'l./ PARCEL TAX I.D.# I �MIT# � <br /> I I ��� - ` /i7C�J -C,�IJ <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION It <br /> DESC. <br /> OWNER ADORESS CITY2IP PkONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �� � � �1�(����1�� <br /> CONTRACTORr� � ` ,� � � ,;�i,.� '��-. ADDRESS CITY2IP PMONE <br /> r�C_.CL2� : � _ � 11 = %��7�I c;L ��1-'c;�. {�1�;C1 �� L�;�' tl���, <br /> CONTR.LICENSE# �^ } � , � -� �r - n <br /> �-�-� v�:>1 �%�.{: 1- �L V'�� :V\i � t�.- � `f �.�'.�— <br /> USE OF BUILDING HEAT SOURCE I CONTRACT.ERICE OF WORK <br /> / =_ - _ <br /> Electric Gas Other I i �_ <br /> ( �i�^�u1"K �i�i��l 1���-1,-.�,`� — — — _ = <br /> WORK DESCRIPTION <br /> � <br /> 1�� .`1)1, �, #��: i.i '��.AI :�-(�1.��- <br /> PLUMBING J MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI7(TURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/b:�/mop/etc.) Exhaust(an <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Four�iain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Root drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing ihis type of work will be complied with whether specified herein or not.The granting ot a permit does not presume <br /> to give authurity to violate or cancel ihe provision of any other state or local law regulating construction or ihe performance ot <br /> consiruction.That I am authorized by ihe owner of�his property to perform the work for which application is made and I comply with the <br /> State Coniractors Law 18.27 RCW and 296.200 WAC. <br /> ,, i _ <br /> Signatu��oniractor/Authorized Agent Date <br />