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P�RMIT APPLICATI�N <br /> CITY OF EVERETT PEF2MIT 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 S–�1-0� <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT# <br /> �' �U 2 �e�('�tE �v 'L ' $05-0 <br />� LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PFiONE <br /> �'��\�� �'�7� �J Z Fve��� -{�J� �U� � �1 U( � � <br /> NANTNAME CONTACTFORPERMIT PHON <br /> I \ �f�Y�'�. E-MAIL <br /> –Z`dN'fkA�' b�§ ' <br /> CONTR.LICENSE N <br /> USE OF BUILDING — HF.AT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION �����\� � ��� �afv�� � R� �7�� ��yyP�.� / S {�S � <br /> Y <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC–air handling unils <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas firsplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Waten c�ater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined this application and know the same to be lrue and correcl. All provisions of laws and <br /> ordinaces governing lhis lype of work wil�be compiied with whelher specified herein or not.The granting uf a pertnil does not presume <br /> to give aulhority lo violate or cancel the provision of any other stale or local law regulating construction or lhe periormance of <br /> construction.That I am authorized by the owner of lhis property to perform the work tor which application is made and I comply with the <br /> Slate Conlractol¢La�18�7 RCW and 296.200 WAC. <br /> �� � � �Z_ �-� <br /> Sic�naWre o(O nar'�Conlraclor/Aulhorized Ac�enl Date <br />