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( ; <br /> P�ERMIT 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 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMR N <br /> 136 i H�� � ( �' oa� - <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDMSION N <br /> DESC. <br /> OWNER ADDRESS CITV2IP PHONE <br /> CN���� �-aaee�.-w <br /> S'PocLs�r4- /-(.teZrs� 13o I f�la�,T(� �-�Jl. �18�.0! yZs251;�l� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> SA,,t� � s r���E E�N� <br /> CONTR.LICENSE N ��m� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> LO ki-i.c5 `F /2E�14:i �— _Electric �Gas_Uther <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIX NRE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A�C—air handling unils <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) �C Gac piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> DackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other _ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicatlon and know the same to 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 grantlng of a permit does not presume <br /> to give aulhority to violate or cancel lhe provision of any other state or local law regulating constructlon or the pedortnance of <br /> constructio�.Thal I am authorized by the owner of this property lo perform the work for which applicalion Is made and I wmply with lhe <br /> St o ractors w 18.27 RCW and 296.200 WAC. <br /> J <br /> /D � _• � <br /> Si ure of nedContracbdAuthorized Agent Date <br />