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F �.RMIT APPLICATIt�N <br /> CITY OF EVERETT RERMIT SERVICES <br /> 3200 CEDAR STRCET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org � ` ��5 <br /> APPLICATIONS ARE ACCEPTED FROM G AM TO 4 P�N - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADGRESS PARCEL TAX I.�J.# PERMIT Yr <br /> � 'Z. 5G �'V�Erc� � f�hGSG�= -U[ ' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDR[55 CITYIZIP PHONE <br /> ]/�4C✓�-s� ( nn10ANG 5 _��i/ S�c� �e2�S% � i �Yt1 CA� �T'I XS-+ �7Q� <br /> TENANTNAME � CONTACTFORPERMIT PHONE <br /> f,�r �,�zi �{,� j �,.._ n�cf.v�r�, ���.l�T/ �s .�i 4Z�2Sz �¢34— <br /> CONTRACTOR r'�/�YC���YIC't�/"A�L ADDRE5533�0 CC�f92 �TY21P PHONE <br /> �:e,e� 4zS�-�s'�. <br /> CONTR.LICENSE# 9B Z.�/ <br /> �VE 2�s�ii�,/n F <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric �r Gas_Olher UC <br /> ,�e�g,L __ — �r��ao <br /> WORK DESCRIP?ION <br /> PLUME�ING MECHANICAL <br /> NO. TYPE OF FIXTUI2E OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathlub Forced air systems <br /> _ Lavarory(wash basin) � Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/elc.) � Exhaust tan <br /> Backflow preventer Heat pump <br /> Urinal 1_ Unit healer <br /> Drinkin9 Fountain Boiler <br /> I, = Floor drain = Refrigeralion <br /> iGrease lrap Woodstove <br /> , _ Roo(drains Olher _ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read end examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing lhis type of work w�il be complied with whether speci(ied herein or not The granling of a permit does not presume <br /> to give authority to viol�te o;cancel the provision of any otl+er state or local law regulating constn;clion or the per(ormance of <br /> construction.That I am authorized by the owner o(this property to per(orm the work for which application is made and I comply wilh the <br /> Stat:Contreclors L.aw 18i 27 f2CW and 296.200 WAC. <br /> l � <br /> S- ,,;,,. i.�, .., ,� � -��� <br /> n ure of Owner C ractor A onzed Ac�ent Date ,�� <br /> � <br /> l. 2 <br />