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PErtMIT APPLICATIOM <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 95201 <br /> 425-257-8810— FAX 425-257-8857—www.���aretteva.org <br /> APPLICATIONS ARE ACCEPTED FRUM 8 APd TO 4 PM �j —a� _Q� <br /> SITE ADDRESS PARC EL TAX I.D.# PERMIT# <br /> �,C04 3411$19 o�l,pp <br /> 3 �� �� C'/n�w � .0 00 L U - <br /> LEGAL LOT NO. �� BLOCK TRACT <br /> DESC. �� � <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �7 U/ <br /> ( � - �� �.. � -�� � �I 3 I Lv��, i r , �G1�' y� = �s� <br /> TEIJANT NAM CONTAGT FOR PERMIT HONE <br /> CONTRACTOR ADORESS CITY/ZIP PF10NE <br /> CONTR. LICENSE K <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> � �,Eleclric Gas_Other <br /> _��/Z — -c� <br /> WORK DESCRIPTION <br /> �m�,�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> J_ Bathlub Forced air systems <br /> �_ Lavalory(wash basin) Gas piping <br /> _L Shower Water healer <br /> _� Kilchen:>ink 8 disposal Gas fireplace <br /> � Dishwasher Gas rango <br /> _ Clolhes washer Clolhes dryer <br /> Water heater � Range hood <br /> � Sink(service/badmop/etc.) �� Exhaust(an <br /> BackOow preventer Heat pump <br /> Urinal Unil heater <br /> Drinkinc� Fountain Boiler <br /> Fluor drain Refrigeralion <br /> Grease trap NJoodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y Uial I have read and examined this applicalion and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governiny lhis type o(work will be complied with whether specified herein or noL The granting o(a permit does not presume <br /> lo give aulhority lo violale or cancel the provision of any olher slale or local law reguiating construction or the performance of <br /> conslruction.That I am authorizedby the owner o(thjs property to pertorm the work(or which application is made and I comply with lhe <br /> State Contractors Law 18.27 RCW and 296.200-1�CC. <br /> ' �--,-�! � ' -3`vZ�06 <br /> �Signalure of Ori�ier oNractor/Aulhonzed� ent Dale <br /> ��a <br />