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�_ - -- <br /> PEI�MIT APPLICi4TiOf� <br /> CITY OF EVERETT PERMIT �ERVICES �, ,a3_n� <br /> 3200 CEDAR STREET, EVERETT, WA 96201 � � <br /> 425-257-8810-FAX 425-257-885�-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM � (�i� 6�G(� �d/ <br /> SITEADDRESS PA`RC�LTAXI.D.# I PERMI q��OC/�O <br /> I� <br /> 0 0 `�vZ3 • �I • C,�•«;> > <br /> LEGAL LOTNO. BLOCK ACT <br /> DESC. (,(�j `` �� _ <br /> OWN R ADDRESS CITYZP PHONE <br /> ��dens t�or�l llC . ,.�µS�I�S•l.kt.S�eve� .,���qB75°�5 - <br /> TENAN7NAME I O TACTFORPERMIT PHONE <br /> COk'(RACTOR AODRESS CITYZP PHONE <br /> 5 a wi.c_ AS alc�ve . <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE GF WORK <br /> —��� _„ _Electnc �Gas_Other 1 �(�J �/a - <br /> l�X <br /> WORK DESCRIPTION <br /> 2fxo0 ���c <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEi:1 <br /> Toilet �..�� " � `� '�/ " A/C-air handling units <br /> Bathtub ✓ `�'✓ � � Furced air systems <br /> ,� Lavatory(wash basin) ���- ;' ,'��� LO Gas piping <br /> � Shower r ✓" 'L Water heater <br /> � Kitchen sink 8 disposal 2 Gas fireplace <br /> � Dishwasher.�;�� , �"' Gas range <br /> z Cbthes washer��'✓� 2 Clothes dryer <br /> Laund tre '�" Range hood�;,.- <br /> — ry Y Exhaust fan�-;��'i� /,// <br /> = Sink(service/badmopletr,.) � <br /> ..- Backtlow preventer -- Heat pump <br /> — Urinal — Unit heater <br /> = Drinking Fountain = Boiler <br /> — Floor drain — Refrigeration <br /> — Grease trap — Woodstove <br /> I — — <br /> — Roof drains — Other <br /> � Other �' <br /> CITY OF EVERETT LOCAL SAL[S TAX COOE IS 3105 <br /> I hereby ceritiy that I have read and examined this application and know the same lo be true and cortect. All provisions of laws and <br /> ordinaces governing this type oF work will be complied with whether specified herein or not.The gra�ling of a permit does not presume <br /> to give authority ro violate or cancel the provision of any other state or!ocal law regulating construction or the performance of <br /> construction.That I aT authorized by the owner of ihis property to perform the work foi which application is made and I compty with the <br /> State Contr�tors 1827 RCW and 296.200 W C. <br /> �j.�a��, ,����� 3�� ��� <br /> Sig ure of Own o tractorlAuthonzed Agent ate <br /> i\I <br /> � yv <br /> - _ _ _ - - - - ---- - --- -� <br /> w <br /> , <br />