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PE.IMIT APPLICATIO. . <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 /> SIT 1�DZaSS �• �� ���� �PARCEL TAX I.�D,.M PERM�T g � OO <br /> ,v�e �5yvb oo�oo fJ w <br /> LEGA LO i NO. BLOCK TRACT OR SUBDIVISION N ' <br /> oESo. 003� oo v�c�tcv. ad d�-h � v�, <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> L\�5c�/ �1�v�o� 3523 �I`i��r. � EVc..-e.44' q�2os N2S'33`1' �130� <br /> TENANT NAM I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> vo i�j�.L�v.1 ('_ov.S�C'�l0`^ � \V��w��2,3 11 <br /> CONTR.LICENSEN ,��� 13S—�3Y <br /> USE OF BU�LDING HEAT SOURCE �py,�¢� CONTRACT PRICE OF WORK <br /> (� Q� _Eledric _Gas_Other <br /> WORK DES RIPTION <br /> �Qi1MU\lS� �0.�/�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas firepiace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mup/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal � Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby certify ih2t I have read and examined this application and know the same to be true and wrrect. All provisions of laws and <br /> ordinances governing this type ot work will be complied with whethzr specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision ot any other state or local law regulating consWdion ar the pedormance of <br /> construction.That I am authorized by the owner of lhis propeAy lo perform ihe work for which application is made and 1 comply wilh the <br /> Sta to aw 1627 RCW and 29 AC. <br /> <i/�`�S-� � lo' � � ( � <br /> Si'gnature�o wnedCon ractodAuthorized Agent Date <br />