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FERMIT APPLICAT�UN <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 g—� 4`D� <br /> SITE ADORESS PARCEL TAX I.D.N PERMR• <br /> /�i6- H�w���-s�- KoBo� -c� <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDMSIfNi/ <br /> OESC. <br /> OWNER ADDRE53 CIT'21P PMONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> EdAAIL <br /> }�'�°r` � 1-c•G �j1%��{- �7`��S.Ir O <br /> 20�229�2� <br /> CONTR.LICENSE N ��N� �n p��„ CG ��� �'1�/� �X���/�- <br /> 7 <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other ��pU <br /> . u� <br /> WORK DESCRIPTION <br /> +JE��LI-�L �oo �rc 4 r�� Sy Doc� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7i1RE OR ITEM <br /> Toilet A/C-air handling units <br /> Balnlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> _ Clolhes washer Clothes d ��� <br /> Water healer _ Range h d <br /> _ Sink(service/barlmop/etc.) _ Ezhaust i <br /> _ Backflow preventer Heat pum��„ <br /> Urinal Unit healer \, <br /> Drinking Fountai� Boiler � <br /> Floor drain Refrigeration �"�, <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined lhis application and know Ihe same lo be true and correcl. All provisions of laws and <br /> ordinaces governing thi;type of work will be complied with whether specified herein or not.The granting oi a permil does nol presume <br /> lo give aulhoriry to violate or cancel the provision of any other state or Iocai law regulating conslruction or the pertormance of <br /> construction.That I am aulhorizeA by the owner of lhis properly to pertorm the work for which application is made and I comply with the <br /> State Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> ���-�_� `7y d� <br /> ignaWre of OwnedConlraclor/Authorized Agent Date <br /> 'IZ <br />