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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.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS pARCEL TAX I.D.# PERMIT# <br /> aa �a��� i�- I m � x�l "n�5 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBOINSION/ <br /> DESC. <br /> OWNER n ADDRESS CITY2IP PHONE <br /> f'r��i �Ll�lUfvUL�C.�i _`)ani�L- <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> EaNAIL <br /> , u,ti�� ��'�7 � wt� � r��. 5���. L�7� �c�� <br /> CONTR.LICENSE; ��O�O, _ G'^` �, "��,���'Lw B �^-l�� <br /> �`xt , ✓ �X c�� �66��. <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,�E�edric Gas Other �� ��-� ,� <br /> WORKDESCRIP710N y����l� ��� `O�n�� <br /> I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C-airhandlingunits <br /> _ Bathtub Forced air systems <br /> _ Lavarory(wash basin) Gas i in <br /> Shower — P P 9 <br /> — Water heater <br /> _ Kitchen si�k&disposal Gas freplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Waler heater Range hood <br /> _ Sink(service/badmop/etc.) Exhaust fan <br /> _ Backflowpreventer � Heatpump <br /> _ Urina� Unit heater <br /> _ Drinking Fountain Boiier <br /> _ Floordrain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roofdrains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS J105 <br /> I hereby certify that I have read and examined this applicalion and know the same to be true and correct. A�I provisions of laws and <br /> ordinances 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 authorily to violate or cancel the provision of any other state or local law regulating wnstruction or the perlortnance of <br /> construction.That I am authorized by the owner ot this property to perform the vroric for which appliwtion is made and I compty with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> � <br /> ��.�� � .�..p, r 41��1 �o <br /> Signature of Owner/ ontractorlAuthonzed Agent Date <br />