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PERMIT APPLICATION <br /> ��� CITY OF EI/FRETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE P.CCEPTED FROM 8 AM TO 4 PM �D ../fj �jJ� <br /> � PARCEL TAX I.D.# PERMIT i! <br /> � SITE ADDRESS <br /> � o oa�-s �. a� zo � o o ya �za ��03/00 0 - a:� <br /> LEGAL LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��r� c�c� lT�-e--�—�^ — �0.�- G-� ��Y� �zS� 3��'QO�`6 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> IV�� I ��nn � ��� 1���� �0� <br /> CONTRACTOR � �/— ADDRESS �- - �+ �� ��:��CITY/Z!P PHONE S c�L� -� <br /> �iJRSN���''`�,� c��r� ,.,5.:.� ��v lr , � -� <br /> ¢-(<«¢��L-; (y��.lx���� j� 5'y5�� <br /> CONTR. ICENSEi! ^ <br /> �U�S/�1��`iS�/l�'l� �� `�?' 3�� -- <br /> USE UF BUIL�ING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eiectric _Gas_Other �3��� � <br /> WORK DESCRIPTION , /� / I`.'-" r`"" <br /> �., 0.�LG�C- �'Lt� � � ,-Q.�'�L-f"�^IG �JQs� <br /> �) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fl%NRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ NC-air handling units <br /> BatlNub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Gas ran e <br /> i _ Dishwasher Clothes dryer <br /> Ciothes washer — <br /> Laundry iray _ Range hood <br /> Sink(service/barlmopletc.) __ Exhaust fan <br /> Backflow preventer __ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ f3oiler <br /> Floor drain _ RetngeraBon <br /> Grease trap _ Woodstove <br /> Roof drains _ Other__ <br /> � Other_ — <br /> C�TY OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> I hereby ceritiFy that I have read and ezamined this application and know lhe same to be We and cortect All provisions of laws and <br /> ordinaces goveming ihis type of work will be complied with whether specified herein or not The granting of a permit does not presume <br /> to give authoriry to violate or cancel Ihe provision of any other state or local law regulating construdion or the performarce of <br /> conslruction That I am aulhorized by the owner of this property to perform the work for which applicalion is made and I compty wilh the <br /> State Contraclors Law 1827 RCW and 296200 WAC. <br /> ��(A 101.�-�e �n -� \'0`b — � <br /> SignaWre of wnedConuacto/Authonzed Agent Date —*' <br />