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. - ----- l <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9B201 �n p'��? <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org ,������ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.1/ PERMIT M <br /> O �1Cr'ic�'��,n AU(,. C�u3�6�1 ���'\C�� fJ" �/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. �� <br /> OWNER ADDRE�SS I C1TY2I1P ��aS <br /> S�ic�� �,o�l��.��uq��� �c� ,�•�� t �� ��x7� Mut� I�rol�'� �3`1-,3`152 <br /> TEHANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR J'G �,� �.*. �L• �R� n -� �a CITY2IP 1 �^ S <br /> `J {_�(.� h n. <br /> CONTR.LICENSE M�GI CG�C`�I GS M�I ^�' �Y O �-�d�� P�C��-��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Sin�� �' Electric ,�,Gas_Other �� (� � � °� b OV <br /> c �'nM�� QeS — <br /> WORK DESCRIPTION � �3/�! ��GZJ�/,J� <br /> -� /lo� <br /> ;�1�� 4z0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel _ AIC–air handling units <br /> Bathlub J_ Forced air systems <br /> �-�=�-- �� Gas piping <br /> � Lavalory(wash basin) <br /> / � Shower Walerhealer <br /> I Kilchen sink 8 disposal Gas fireplace <br /> I Dishwasher � Gas range <br /> � Clolhes washcr � Clolhes dryer <br /> Laundry tray � Range hood <br /> Sink(servico/badmop/etc.) � Exhausl fan <br /> Backflow prevenlor _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 7105 <br /> I hereby ceritify lhal I have read and examined lhis application and know the same to be true and correct. All provisions o(laws and <br /> ordinacos c�overning Ihis ly pe ol work will be complied with whether specified herein or nol.The granling o(a permit does nol presume <br /> lo c�ive authonry to violate c r cancel the provision ol any other stale or local law regulating wnslruction or lho pedormance of <br /> construction.Tha� I am aulliorizod by lhe owner of Ihis propeAy to perfortn lhe work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW a�d 296.200 WAC. <br /> �y-� �� .�-�- � �15-�'� 'fz <br /> Signature o wnerl onlractorlAuthorized Agenl a��— <br /> /'l�'Z - - d21�' <br />