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FERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— F/iX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCFPTED FROM 8 AM TO 4 PM <br /> SITE_A'DDRESS � DOPARCELTAXI.D.p PERMIT bl 'u� <br /> `I 90 9 � �)o� -� 4 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. �,� �I�-UD E��. I5t !"1 � 1 <br /> OWNER ADDRE55 CI IZIp PHONE <br /> 6 NANTNAM��hSZS LL ( _ LfSrJ� E ���Q (JQVY�W1� 1�1� S�NW(L�� ���CZ �I.ZS-�?(�'O S <br /> ICONTACT FOR PERMIi PHONE <br /> �Q�e /V1D0�-e_ 20� -ZZ b-�S� �j <br /> CONTRACTOR L,� NO✓l�Q� �r��L � ADDRESS a� pTY21P PHONE <br /> CONTR.LICENSE# SO� /UJ� � N� �1�'v✓� �ZZ� �O�o-Z2'p -�S,Z�� <br /> �s.vHO � �c �gb �+ P <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �L`��1��:D✓� I _Electric _Gas_Olher <br /> WORK DESCR�PTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C-air handling units <br /> _ Dathlub Forcedairsyslems <br /> _ Lavatory(wash basin) — <br /> Shower ._ Gas piping <br /> — Water heafer <br /> _ Kilchen sink&disposal Gas fireplace <br /> Dishwasher — <br /> Clolhes washer — Gasrange <br /> — _ Clothes dryer <br /> _ Water heater Range hood <br /> _ Sink(service/ba�/mopletc.) Exhaust fan <br /> _ �ackflow preventer Heal pump <br /> _ Urinal Unit heater <br /> _ Drinkin�Fountain Boiler <br /> _ Floordrain Refrigeralion <br /> _ Grease irap — <br /> Roo/drains _— �✓oodslove <br /> Other _ Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i hereby cerilify that I havo read and exarnined lhis application and know lhe samo to bo true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will bo comp�ied wilh whether specified herein or not The granting of a pertnit does not prosume <br /> lo give authority to violate or cancel tho provision of any other stato or local law regulating construction or the perfortnance of <br /> consiruclion.That I am authorized by Iho owner of this property to pedorm the work for which applicalion is made and I comply with the <br /> Stale Contraclors Law 18.27 RCW and 296.200 WAC. <br /> �,"' F��I1`U� .�^�, (vy' ' <br /> !�-t�.4 J����ti� .�� a�/p�- <br /> Signalure o�OwnedConlractor/Authorzed Agent Date <br />