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—� �� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610-FAX 425-257-8857-www.everettwa.org �,� �-a.3�b6 <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> as�� H�W,t� a�� 1� v � C -G(0 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Wo�1c �P�o,-f�..iti�s p�tzr L:Ilesve ya5-8Kt -o�oo <br /> CONTRACTOR ADDRESS CIN21P PHONE <br /> �,,�e.S{-erv� 5'1�.kzs -C�.r� �otzC�io.. -��o� l$O�`' lave N� (Z��„�� y15-55`6l -OIO <br /> CONTR.LICENSE tl S�"�� A—(�s QbOSd <br /> WFSTESF ��NC1C' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Q�,`Qy I _Eiectric _Gas_Olher ���� <br /> WORK DESCRIPTION !� <br /> RClOCc.fio+� c� -1 sPr�.�kter �faG�S CtKQ '� '{C"�a�+'� �^^p+bver�eh'�i <br /> SPo.c:.-.� co«plies wilti NF (�A �3, <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Laundry(ray _ Range hood <br /> Sink(servicelbar/mop/etc.) _ Exhausl tan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Reirigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this applicalion and know the same to be true and corced. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whe�her specified herein or nol.The granling of a permit does not presume <br /> to give authority to violate or cancei ihe provision of any other state or local law regulating wnslruclion or the performance of <br /> construclion.That�am authorized by ihe owner of this propeAy to perform the work for which application is made and 1 compty wilh the <br /> State CoNractors Law 18.27 RCW and 296.200 WAC. <br /> �i ,�L;.� 10l13106 <br /> Signature of OwnedConUactodAulhorized Agenl Dale <br />