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PERMIT APP�ICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 . <br /> 425-257-8810— FAX 425-257-8857—www.everettNa.org � ya�y� <br /> APPLICATIONS ARE ACCSPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS / 7 Q2 S E pARCEL TAX I.D.* PERMIT# <br /> EuE�?,Ej,j MAL.G ( ' OSG�I-U <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER // SAW IJI�IC�N '�/ � �`,���(I/� PHONE <br /> sT��b F�vs`v �, aoy ���9 �s�o�d� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �/��d' �.v��/ ���<« �,n,���r�� yas�� ���f <br /> CONTRACTOR ��'�U � /��DqRESS -3 CITY/ZIP PHONE <br /> (J ��� �� �v� ��nNn y�5 �7 965� <br /> CONTR.LICENSE#�r/9/'JF�///��/�, / ' <br /> �..r�� � ivc�v <br /> USE OF BUILDING HEAT SOURCE CONTRACT P,'ICE OF WORK <br /> /77J,���°�f,{�j-/L�— _Electric _Gas_Other l� C/�i� `"� <br /> WORK DESCRIPTION <br /> �.;� � '�,; /`= � � _ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Balhlub Forced air systems <br /> Lacatory(wash 6asin) _ Gas piping <br /> Shower _ Water heater . <br /> Kitchen sink&disposal t� � _ Gas fireplacz � <br /> __ Dishwasher �s~� C'� _ Gas range <br /> Clolhes washer �C�.' .a. s� _ Clolhes dryer <br /> _ Laundry tray �'��' r \ _ Range hood <br /> _ Sink(servicelhadmop/etc.) ��. �`� ^ _ Exhaust fan <br /> Backflow preventer ('�" � �1 _ Heat pump . <br /> _ Urinal ,`o�tt�� _ Unit heater <br /> Drinking Fountain � � _ Boiler <br /> i Flnordrain � �r _ Refngeration <br /> — Greasetrap �������L Woodstove <br /> Roo`drains � � Z Other FI�P� 3PR/vuce(Z <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � . <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work wiil be complied wilh whether specified herein or not Th=granting ot a.permit does net presume <br /> to give au�honty to violale or cancel the provision of any olher state or local law regulating conslruction or the peAormance of <br /> consiruclion.That I am aulhorized by lhz owner of this property to perform the work for which appfcation is made and I comply with the <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> C� i' .,� <br /> �gnature of Owner/Contredor/Authorized Agent Date i i"i,'� '� 7 <br />