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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 A PARCEL TAX I.D.# PERMIT# <br /> o (S (�'�Ar� h�✓r- lU(a�. •-O`5 <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIL'P PHONE <br /> �� B ��,i v � �� �s Cn�o A�� 9�z�1 4z�-.���,- y4�- <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR 5(-"�VIGti �IS LIIM � ADDRESS %uJ/I 3/���_ CITYIZIP � PHONE !/2S •>�S�q <br /> n Lv <br /> CONTR.LICENSEN S�:•V`�JI" `' U� ( Q3� ��Z� <br /> USE OF BUILDING HEAT SO;iRCE CONTRACT PRICE OF WORK <br /> St.,e I �,es ��;/�(� _Eleclric _Gas_Other <br /> '',r— <br /> WORK DESCRIPTION <br /> � l�c.� 9 ��� W � �r-� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas pipin9 <br /> Shower ( � Water heater <br /> Kitchen sink&dlsposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes�1ryer <br /> Laundry tray _ Range hood <br /> Sink(service/barlmop/etc.) _ [xhaust fan <br /> BackAow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boilcr <br /> Floor drein Refngeration <br /> � Grease trap Woodstove <br /> � Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby centify that I have read and examined this application and know the same to be tme and correct. All prowsions of laws and <br /> ordinaces goveming this rype of work will be complied with whelher specified herein or not.The granting of a pertnit does not presume <br /> ro give authonty to violate or cancel the provision of any other siate or local law regulating wnstrudion or the pedortnance of <br /> ronstruciioa That I am authorized by the avner of ihis property to perform the work for which application is made and I comply Hnth the <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> � �j_-- y_ g�_o6 <br /> S�gnature of Owner/Co tractor/Aut onzed Agent Date <br />