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\ - <br /> F �cRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CFDAR STFtEET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> .APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ✓ _ a '3-D{ <br /> PARCEL TAX�.D.# PERMIT# _ �� <br /> SITEADDRESS LN � ��6j S <br /> 0 3�/ GZc�i <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> D��i� i�2�r�c�s�v 3o3y c2�i �nr� � �.�r r"azo3 Y2s-�1y=i z� Y <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.Lic�� ��i�.�2T/J�r.�77L L/2 o N�t/t"/� �l/� FL� �$lO I �s2 ���1 j <br /> E'��S.S��O/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /J!z�G����.t ( _Eleciric ,�CGas_Olher y 2 BO Q <br /> �K�' <br /> WORK DESCRIP710N <br /> �.zsi�it� GflS f=�r/t��9� ' ��T <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> _ Bathlub � Forced air syslems <br /> _ Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl tan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woodslovo <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity lhal I have read and examined lhis application and know lhe same to be true and correcl All provisions of laws and <br /> ordinaces c�oveming this type of work will be complied with whether specifed herein or�oL The granting of a permit does not presume <br /> lo give aulhority to violate or cancei the provision of any other slate or local law regulaling construction or the peAormance of <br /> consWcl�n.�hat I am authorized by the owner of this properly to pertorm the�vork for which application is made and I comply with the <br /> Stale Contrac or�s w 18.27 RCW and 296.200 WAC. <br /> Y� /J��—� 5- � z- oG <br /> �gnaWre of OwnedContractodAulhorized Agent Date <br />