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SITE ADDRESS <br />�.T,l-t.i- CRIrCfr <br />LEGA�T NO. <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 />A <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />BLOCK <br />TRACT <br />?ARCEL TAX I.D. # <br />RMIT # _ —7 <br />c- 7o 0,. / <br />OWJJER ADDRESS C17YlZIP P110NE <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />CONTRACTOR <br />CONTR. LICENSE # <br />r1 _ IT / ADDRESS <br />bLVJ <br />CITYrzIP <br />PHONE <br />L,,Z 5 4-4 -7 4-5CO <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />_ Electric _ Gas _ Other <br />WORK DESCRIPTION <br />�1 �e1►nk„� C) <br />- PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />_ Toilet <br />_ Bathtub <br />_ Lavatory (wash basin) <br />_ Shower <br />_ Kitchen sink & disposal <br />_ Dishwasher <br />_ Clothes washer <br />_ Water heater <br />_ Sink (seRice/bar/mop/eta.) <br />_ BackFlow preventer <br />_ Urinal <br />Drinking Fountain <br />_ Floor drain <br />_ Grease trap <br />_ Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothee dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 310S <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I 4m authorized by the owner of this property to perfo, m the work for which application is made and I comply with the <br />State Contractgrs L 1f1%.�27 R[W and 296.200 WAC. <br />, <br />Signature of uwmp'conirvcr /Aumonzea myenr �a,� <br />