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1 I <br /> PERMIT 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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> S�TE ADDRESS PARCEL TAX I.D.# P RMIT S <br /> � � ,'i ; ,, a, VCYr�II q���� o� nh �1 ,..�1-I �,:�c. , . _ j � J - �I <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. � � 00� D�02 !j�i, . ?� `I.� � ! �lLl= � ., , ri . <br /> OWNER ADDRESS CITY2IP PHONE <br /> , , � �i �j . , � , -..�� '�� 11 '�?�)��3 A:5)"�'I�� 225Z <br /> , ,� ii: � � '. 1,5174'1 �n� � l' 4J4JV1 �=�' �' � <br /> TENANT NAME I CONTACT FOR PERMIT PnONE <br /> CONTRACTOR '�YJ ��`r'�/':fG�II ADDRESS CITYZP PHONE ^ <br /> y �/�;'� ��"�.^ .o � <br /> J'�� <br /> CONTR.LICENSE It u� ����� I�� � �,,I� <br /> USE OF BUILDING I HEAT SOURCE I _CO�iTRACT PRICE OF WORK <br /> i :,�', <br /> ',� � -' , �Eloctric _Gas_Olher . ,;,:' <br /> WORK DESCRIPTION � <br /> . ;,a� � I�qic�l �nkvcorri <br /> , . , , ✓ <br /> PLUMBlNG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink &disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Cbthes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbar/muplelc.) _ Exhaust fan <br /> Backflow proventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Ro(rigeration <br /> Grease hap _ Woodstove <br /> Root drains Othor <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined this application and know the same to be true and correct. All provisions ot laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The g2nting of a pertnit does not presun�e <br /> to givo authoriry lo violate or c2ncel tho provision of any other slale or local law regulating construction or the performance of <br /> construction.That I am authorized by lhe owner of this property lo periorm the work for which application is made and I comply with lhe <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> �� `-;f�w�-�,� �:�,�,�,,,, �-��-��. <br /> Signature of OwnedContracror/Authorized Agent Date <br />