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P�RMIT 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 PARCEL TAX I.D.# PERMIT/ <br /> 2326 �'�►�Q �} �nouo _ � <br /> LEGA LOT NO. BLOCII TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> RCi1�5�1 S JYLanGr Z32� P�v�¢ St E�Pre{} q8?l�� N25-25�-tiu3 <br /> TEN NAME CONTACTFORPERMIT PHONE <br /> '— RUr�'� Sc�"qnu y7h�-2�� - i i N3 <br /> CONTRACTOR ADDR SS CITY2IP PHONE <br /> CONTR.UCENSE p �G f � `� <br /> l� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> �^ t�� �Gl� i`-a �- t1� /� °`-� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub 1 Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower J_ Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heaWr Range hood <br /> Sink(servicelbarimop/elr..) Exhausl tan <br /> Back(low preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby cerili(��that I have read and examined lhis application and know lhe same to be lrue and conecl. All provisions of laws and <br /> ordinaces c�oveming lhis lype of work will bo complied wilh whelher specified herein or not.The granling o(a permit does nol presume <br /> to gi �e authoriry lo violate or cancei the provision of any olher slate or local law regulaling consWction or lhe pedortnance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Slale Contractors Law 18.27 RCW and 296200 WAC. <br /> ��,(� � � �/�,� I <br /> </14 �14/IC/1�/la I' ZEj —�(� <br /> Signature of Owner/Conlractor/Authorized Agenl Date <br />