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P�RMIT ARPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA fl8201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED I <br /> PARCEL TAX I.D.N PERMIT/ � <br /> SITEADDRESS nve � ��_0�� <br /> 3 � a�r i-i <br /> LEGA LOT NO. BLOCK ��T G�^>0 I �Z�_ Z�� — �36 t <br /> DESC. /6 L ��� <br /> OWNER ADORESS CITY2IP PH NE . <br /> 3r ,�� ka�.sl� � <br /> I CONTACT FOR PERMIT PHONE { <br /> TENANT NAME � <br /> 1 <br /> CONTRACTOR / ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE N !�K��S ��S��// <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S�� _Electric _Gas_Othar <br /> WORK DESCRIPTION <br /> �j �-%z� ,S�r'j J�-- <br /> PLUMBING MECHANICAL <br /> NO. <br /> TYPE OF FIXTURE OR�TEM NO. TYPE OF FIXTURE OR ITEM <br /> AIC—air handling unils <br /> _ Toilet Forced air systems <br /> _ Bathtub � Gas piping <br /> Lavalory(wash basin) Water heater <br /> _ Shower � Gas fireplace <br /> _ Kitchen sink 8 disposal Gas renge <br /> _ Dishwasher — Ctothes dryer <br /> _ Ctothes washer — Range hood <br /> Laundry tray Exhaust fan <br /> _ Sink(service/badmopletc.) — Heat pump <br /> Backflow preventer — Unit heater <br /> _ Urinal i Boilor <br /> _ Drinking Fountain — Refrigeratian <br /> Floordrain — Woodstove <br /> Grease trap — Other <br /> Roof drains — <br /> Other — <br /> CITY OP EVERETT LOCAL SALES SA%CODE IS 3105 <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 goveming this type of work will be compliod with whether specified herein or not.The grantlng of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perfortn the work for which applicalion is made and I comply with the <br /> State Contractors Law 1827 RCW nd 296.200 WAC. /I/�� lo L/ <br /> Sig a ure of 0 ne C n�ctor/Authonzed Agent Da� <br />