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i <br /> 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.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM 4 �l D `�Dy <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT* <br /> i5�r o.ok5 AI�� �d-��c f� <br /> LECa LOT NO. BIOCK TRACT OR SUBDMSION II <br /> DESC. <br /> OWNER ADORESS 21P <br /> l�'1� Ir� k�l 11�.�san �s—r� D� � g �dg,�rt� �'tdzo� �; 7� <br /> TENANTNAME I CONTACTFORPERMR PHONE <br /> EilAll <br /> CONTR.LIC£NSEN ��n.g� <br /> USE OF BUILDING HEAT SOURCE I�NTRACT PRICE OF WORK <br /> ��;�j�n,�y�p ( _Electric Gas_Other ��D � � <br /> WORK DESCRIPTION <br /> c�,��,h� o; � ,�,� .�e � y,� �,��;�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FtXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmopletc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigerallon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OP EVERETT LOCAL SALES TNC CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applica6on and krrow the same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied with whether specified herein or not.The granHng of a permft does not presume <br /> to give authority to violate or cancel lhe provision of any other state or local law regulaling constnictlon or the performance a( � <br /> construction.Thal I am authorized by the owner of this property to perform the work for which applicadon is made and I comply wilh the � <br /> Stat raclors Law 18.27 CW and 296.200 WAC. � <br /> `�'� �� '�- ��/a � <br /> Si nature of OwnedContractor/Aulhorized Agenl at�— <br /> ar, 1.��` (�C<k Sg+� �A��-erc S ¢o? P�' <br />