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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SE.�VICES <br /> 3200 CEDAR STREET, EVERETT, WA y8201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED PROM 8 AM TO 4 PM � �a�7 �I(� <br /> SITE ADDRESS Z�2�Q�� PARCEL TAX I.D.# PERMITit <br /> �G� C�� ZC7 1 ' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER 2�2� ,/��, L� Z DDRESS /�' �CITYIZIP PHONE <br /> �� �'Z� QGGGb <br /> �,�e������- 9g2o r �z�-z5p_ og6 <br /> TENANT NAME I CONTACT F R PERMIT PHONE <br /> E-MAIL <br /> �� T R r. DDRESS //�� C TYIZ P P. <br /> G(l�����s f�l�� 3'�D:� S �L�`j^/��[J� ��pO /' �25, 3d 3. �B�' <br /> CONTR.UCENSE M /' ��LZC2 /. ` � ( O ZO! <br /> Gf�'/�/ l!`7l���i�'/� �-� <br /> USE OF NUILDING�Cz�%2%� HEAT SOURCE CONTRACT PRICE OF WORK <br /> l���5 � _E�ectric �Gas_Other �Z(�'��('�C <br /> WORK DESCRIPTION � � .�.., SL�� "GQ[ , <�� ��� <br /> ��� i 1 �7� LO''�������:�� �-2 S�� <br /> �� �C J���� �car o��- `�` <br /> PLUMBING MECHANICAL <br /> NO. TYPE UF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Dathlub Fo�ced air syslems <br /> Lavalory Qvash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink (seivice/badmop/etc.) Exhaust fan <br /> [3ackflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Foun�ain Boiler <br /> Fioor drain Refrigerelion <br /> Grease trap Woodstove <br /> Roaf drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby certi(y Ihat I have read and examined this applica!ion anJ know the same to be true and correct All provisions o(laws and <br /> ordinances goveming Ihis lype of�vork will be complied witn whether specified herein or not. 1"he granting of a permit does not presume <br /> to give authorily lo violate or cancel ihe provision of any olher state or local law regulating construction or the periormance ef <br /> conslruction. That I am aulhorized by the owner of lhis property lo peAorm the work for which application is made and I :omp?�wilh lhe <br /> State Contraclors Lav� I827 RCW and flfi200 WAC. <br /> �� � c � -2S��10 <br /> Signature o(O�a edContractor/Authorized Agent Date <br /> � �'.5� �5�� fi��C�� <br />