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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STt2EET, EVERETT, WA 98201 <br /> 425-257-88?0— FAX 425-257-8857—www.everettwa.org <br /> APPLICATION� ARE ACCEPTED FROM 8 AM TO 4 PM �) _a-�_Q� <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.N P�RMIT* <br /> ,�108 C� n l �f WP ���/ �1 � 2"bS"Z- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE4�-yYy��_7� <br /> Rnl�%�- Fle��- �- fc�� ��du,s � i�f'' ��e SE cvv,�-,,�.-,�5�, 9��a <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> EaYIAIL <br /> A �� <br /> Ca.r�P�.Q � <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��Jl�n C _Electric ✓ Gas_Other �o?��, U U <br /> WORK DESCRIPTION <br /> PLUMBIN MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handlinc� units <br /> Ballriub � Forced air systems <br /> Lavalory(wash basin) � Gas piping <br /> Shower �_ Water heatet <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Ranc�e hood <br /> Sink(service/bar/mop/elc.) _ Exhausl fan <br /> Back(low preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeretion <br /> Grease lrap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY UF EVEReTT LOCAL SALES TA7C CODE IS J105 <br /> I hereby ceritify thal I have read and examined this application and know U e same to be lrue and correcL All provisions of laws and <br /> ordinaces goveming this lype of work will be complied with whether spocified herein or nnL The granting ot a permit does not presume <br /> to give aulhoriry to violate or cancel lhe provision ol any olher state or local law regulating construction or lhe perfortnance o( <br /> construclion.Thal I am authorized by the owner of this property to per(orm lhe work for which application is made and I comply with lhe <br /> State Contraclors Law tb.27 RCW and 296.200 WAC. <br /> �,��, �-L.C c' 7 �a�-�]'{U <br /> SignallMe ot OwnedConlractorlAuthonzed Agent Date <br />