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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320U CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-9857 —www.evereltwa.org <br /> -�1 (�_ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> S�� I�RLOS �G{/d.f_ ��l'd G� PARCEL TAX I.D.# I (PE��� n I/ <br /> LEGA LOT NO. BLOCK CT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADDRE55 CITY2IP PHONE <br /> � `0 �5 l�/ 1� <br /> TENAN NAME CONTACTFORPERMIT PHONE'J � <br /> / / <br /> D/�l_.. z[�(� Z Z� E�-MAIL ', <br /> �b�i��RA TQR �ADDRESS C I IP ON <br /> CONTR.LICENSE N / � `[�/,� „' '_` _ " (,{� <br /> �% JJ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Clectric Gas Other <br /> WORK DESCRIPTION . � <br /> /� a�c� 3oy � (-����. ���5' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet � A/C–air handlinc� unils <br /> � �athlub �/ � Forced air systems <br /> Lavalory(wash basin) � �� Gas piping <br /> Shower Waler healer <br /> —T Kitchen sink&disposa� � Gas(ireplace <br /> � Dishwasher Gas range <br /> � Clothes washer � Clothes dryer <br /> _ Water heater � Ranc�e hood <br /> Sink(service/bar/mop/elc.) Exhaust fan ��// <br /> f3acktlow prevenler _ Heal pump <br /> Urinal Unit healer <br /> Drinkinc� Fountain _ �oiler <br /> Floor drain Re(rigeralion <br /> Grease lrep _ Woodstove <br /> Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined this application and know the same lo be lrue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be compiied wilh whether specilied herein or noL The granting of a permit does nol presume <br /> to give authority to violate or cancel lhe provision of any other state or�ocal law regulaling construction or lhe peAormance of <br /> consiruclion.That I am authorized by the owner ol this property to perfonn Ihc work toi which applicalion is made and I comply with th� <br /> Slate Conlractors Law 18.27 RCW and 296.200 WAC. <br /> 10� 31 �1��- <br /> Siqnature of OwnedContrector/Aulhorized Agenl Da e �/ <br /> 2 <br />