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PE��tMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLIGii f iONS ARE ACCEPTED FROM 8 AM TO 4 PM `�� 3—D7 <br /> SITE ADDRESS PARCEI TAX I.D.N PERMIT N <br /> � � �1 . 9 ! Z � - � <br /> LEGAL LOTNO. � BLOCK TRACT <br /> DES0. � <br /> OWNER AOORE55 CITY/ZIP PHONEN.L�._ <br /> w,: .1� A.t L- .. , q`5Lu3 � 1- 4V 63 <br /> TENANTNAM[ I CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADDRESS CITV2IP PHONE�"gi.y <br /> G.�.q.n S..•��..U�rw� S..c 1�\b�t. S-.ti.\y �7t. 8�...x mn^�Cu.\4 1460- o1V3• �L`a 1Y <br /> CONTR.LICENSEN � y�rL1� <br /> QNo6e zay61 LT <br /> USE OF BUIl91NG HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��ec- I _Electric�,Gas_Other � �{ZZ V , �` <br /> WORK DES�RIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI'(TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air hand�ing uni4s <br /> Bathtub Forced air systoms <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&dispcsal � Gas fireplace <br /> Oishwasher Gasrange <br /> Clotheswasher � Clothasdryer <br /> Laundry tray � Range hood <br /> Sink(service/bar/mop/elc.) _ Exhausthan <br /> _ Backflow praventcr — Heat pump I <br /> Unnal Unit heater <br /> Drinking Fountain Boiler <br /> Floor droin . Relrigemtion <br /> Greasa trap Woodsrove <br /> Roof dreins Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I horeby ceritify that I have road and examined ihis application and know the same M be true and corted Ail provisions ot laws and <br /> ordinacas goveming this type of work will be complied with whether spedfied heroin or not.The granting of a pertnit does not presume <br /> to give aulhority to violate or cancal the prcvision of any other state or lacal law regulating wnstruction or the peRortnance of <br /> consWction.That 1 am authorized by the owner of this property to perfomi the wvrk for which application is mado and I comply with the <br /> Slate,Contractors Law 18.27 RCW and 296200 WAC. <br /> I _ � � <br /> j � ndtu of Ow ar/ ntractodAuthonzed Agent ' Da <br /> I <br /> L_ <br />