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-17-10 09:16A _ t <br />--- ---- PERMIT <br />APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-25 i -8857 - www.everettwa.org <br />P.02 <br />- - APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />/ 01_l.� <br />r EGAI. LOT NO, BLOCK TRACT OR SUBDIVISION N <br />DESC. <br />OWNER -- ADDRESS CITY/zIP PHONE <br />(21 efi IAl t2j =Zj_,7• /Z�� <br />TENAI4T NAME CON ACT FOR PERMIT PHONE <br />_ ?- <br />E-MAIL <br />_ _ <br />CONTRACTOR --------- - -A DR1f ESS -� taIT1 IP PHONE <br />�y�6n <br />CO TR LI Et{SE # <br />Y� ANSs' ? it <br />USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br />f j Electric _—Gns _Other <br />WORK DESCRIPTION � 5_3 <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tuilut <br />Bulhtuh <br />_ l avalory (wash basin) <br />Shower <br />Kitchen sink 8 disporhl <br />_ Dlshwashor <br />_ Clothes washer <br />_ Waterhemnr <br />Sink (sorvice/bat'/mop/etc.) <br />Bnckflow pi oventer <br />_ Urinnl <br />_ Drinking Fountain <br />Fluor drain <br />Grease trap <br />_ Roof drains <br />Other <br />--MECHANICAL - <br />NO, TYPE OF FIXTURE OR ITEM <br />Z_ A/C - air handling units <br />_ Forced air systems <br />Gres piping <br />Water healer <br />Gns fireplace <br />Gas range <br />_ Clothes dryer <br />_ Range hood <br />_ Exhaust fan <br />Heat pump <br />_Unit heater <br />Boiler <br />Refrigeration <br />Woodstovo <br />CITY OF EVERETT LOCAL :TALES TAX CODE IS 3105 <br />I hereby corilify that I have read and examined this application and k Tow the same to be true and correct. All provisions of laws and <br />Ordinaces guveming this type of work will be complied with wholher::pecified herein or not. The granting of a permil does not presume <br />to give aulhurily to violmo or cancel the piuvisiun of any othor state Or local law regulating construction or lho performance of <br />construction. That I ant authorized uy the ownor of this property to perform the work forwhich application is made and I comply with the <br />Slate Contrgkdois 1 aw 10.27 RCW and 290.200 WAC. <br />Signatum o1 Owoor/Csuntractor/Author17ad Agent Date <br />