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;,; 5 _ �,i -����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 io - 6 -�o <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> , �. f �9U �io9�'oD � � - o � g <br /> LEGAI LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP rHONey,�s 3p3•G/,�� <br /> � l 5��er' i//� s i 3 c E�.a-�` � F ��10� <br /> ENANT NAME I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTR OR DRES C YIZ P <br /> CONTR.LICENSE# c.���,,�,?✓/� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas�i�ther <br /> � � d45 � — <br /> WORKDESCRIPTON �.(Qcf z ��xay ���C 6u� l�^y <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling unils <br /> Bathtub _ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clo�hes dryer <br /> Wa�er healer _ Range hood <br /> Sink (service/bar/moplelc.) _ Exhaust fan <br /> Dackflo�v prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> Urinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease Irap ,_ Woodstove <br /> Roo(dr�ins _ Other <br /> Olher — <br /> CI7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify ihat I have read and examined this application and know lhe same to be true and correct All provisions of laws and <br /> ordin�nces governing this lype of work will be complied wilh whelher specified herein or not.The granting of a permit does not presume <br /> to give au�hority lo violate or cancel ihe provision of any olher stale or local law regulating construction or the performance o( <br /> construction. Thal I am authorized by ihe owner of this property lo perform the�vork for which application is made and I compiy with the <br /> State Contraclors Law 18.27 RCW and 286.200 WAC. <br /> f ' �/U <br /> Si,qna ure of er Con ra dAuthorized Agent Date I�Z <br />