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( � <br /> PE�MIT 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 q --� 3 --{(� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ;�.�`,t-I (.�w�8�-� A�%� \ � � �I <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��s �s�� 2m�s t-��ti3� ,�JE ��o � � �a t� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �J��C I S-�w �N��� E-MAIL K�SY�Arc�� / C �Clil� ��i+a <br /> C NTR C OR ` � ADDRES �Z� P <br /> `��-� <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRiCE OF WORK <br /> vAc�Jr _Eleclric�Gas_Other �,�Qf� � � OQ� <br /> WORKDESCRIPTION ��� -r�,��^�F/� �, ��(,��'YV�CS1'lii �-5��/;" � GU�(:,�115' <br /> t � / � <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM Ntl. TYPE OF FIXTURE OR ITEM <br /> Toilet _ NC-air handling unils <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kilchen sin�&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Cbthes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink(servicelbarlmop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drair _ Refrigeralion <br /> Grease trap _ Woodslove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined lhis application and know the same to be true and correcl. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.The granting ot a permit does not presume <br /> to give authority to violale or cancel the provision of any other state or local law regulating construction or lhe performance of <br /> construction.Thal I am authorized by ihe owner of this property to perform the work for which application is made and I comply with the <br /> State Nractors Law 18. RCW and 296.200 WAC. <br /> ��, ���i�d <br /> / <br /> Signature of O nedContractor/Authonzed Agent ' DT— <br />