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( <br /> PERMIT 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 PARCE'_TAX I.D.# ER T#/ <br /> ,< , UU�/ 2 a / � � 3� <br /> LEGAL LOT NO. BLOCK TR1AC�T OR SUBDIVISION M < <br /> DESC. IU I Z Z� ��l l:1 cb (, T-S � Q TU CS/ 2/��'� <br /> OWNER ADDRESS CITY/ZIP , 1 PNONE <br /> � IOS �(�In /� I IL�tec[IS � t � � GrQ �nct" ��lCre yI rwas \ �70 <br /> TENANT NA E I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> ��p� DDRESS I I P H E <br /> CONTR.LICENSE It %// �J �,,�J �ZS� [,,��- L 0 L � <br /> L/ -- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF Wt)RK <br /> � �2 � � _Eleclric _Gas_Other '%�� ���� — <br /> WORK DESCRIPTION <br /> �� �Y�O�U� <br /> / <br /> Q��'L44% �ql7►t�� G/aRnG` ��f�r� 57��-1 W4(.� (�P. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavator�(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchon sink 8 disposal _ Gas tireplace <br /> Dishwasher Gasrange <br /> Cloihes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/etcJ _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinai Unil heater <br /> Drinking Fountain _ 6oiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same lo be lrue and correct. A�I provisions of laws and <br /> ordinaces c�ov�rning lhis rype o(work will be complied wilh whether specitied herein or nol The granting o(a permit does not presume <br /> lo give aulhoriry to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construclion�,Thal I am aulhorized by lhe owner of lhis property to pertorm the work for which appiicalion is made and I comply with the <br /> Stale Con� !•tors w 18.2 RCW and 296.200 WAC. �./ <br /> � ' .^/ 5 2�U Y <br /> ig ature f OwnedConlractor/Aulhorized Agent ��te � <br /> I � <br />