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r r- <br /> PEI�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—wuvw.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �d ,,,3 p—OG <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT� <br /> ;'���.���. ��' � � .�-�_ YV10(�l0'-0(��1 <br /> LEGA LO7 NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �>Z� 3Su13�/ <br /> �-,cr�J iPn-i�-i,�;r,d� 10.3�� �lE�f'.' ��h �.t G f/E/F'EJi� %��9 vPYo� <br /> TENANT NAME I CONTACT FOR PERMIT PH NE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE M O(/J/�-�'L/ <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S � _Electri� _Gas_Olher <br /> WORK DESCRIPTION <br /> � /��� S� / �if�=� � � :��_. <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR 17EM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas rango <br /> Clothes washer Clothes dryer <br /> Water heatar Range hood <br /> Sink(servicefbar/mop/elc.) Exhaust fan <br /> BackFlow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains O:her <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or nol.The granting oi a permit does not presume <br /> to give authority to violate or c�ncel the provision of any other state or local law regulating construcdon or the perfortnance of <br /> construction.That I am authorized by thv.owner of this property to perfortn the work for which application is made and 1 comply with the <br /> Slate Coniraclors Law 18.27 RCW and 296.200 WAC. <br /> %nh�G 0 �'4r��J-�'L �G) • �O - O 6 <br /> ignaWre of Owner/ o lractorlAuthorized Agent Date <br />