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PERMiT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320D CEDAR STREET, EVEFlETT, WA 98201 <br /> 425-257-8810—FAX 425-257•8857—www.Pverettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO�PM <br /> SITE ADDRESS PARCEL TAX I.O.�i PERMIT j <br /> ; �3n �,c� �- a� ���- n,o�3�o00o I�oco '� - 3 S <br /> I.EGA LOT NO. /_ BLOCK TAACT OR SUBDIVISION 1 <br /> DESC. I W t�.)��v�°r�l.�� II�a��e S��tS �iv , +� vl p� <br /> OWNER ADDRESS / CITY2IP ��7�_ 3�I7. �1$7 g <br /> l�c��Ct � llr��l � 93C� l�4� r����u� �t��c £� ��r�L���� 9�Z��� <br /> TEN/WTNAME I COf�TACTFOR/p�ERMIT / PHONE ,JZ7_3yj_��Z/t! <br /> :J�� /�IQ,/(.C� P ��/��P� � ` <br /> e�a� J,�� ,QII�Pd�l�✓fr�Ia7 �+%1" <br /> ilcl�e� %7��1/l9fio,v �i1C �lPhvY �}w'�f `) `� � /Ul 1%- 7'/5-�`� 77 <br /> CONTR.LICENSE�I L�11 h W�u��. W� ����7 <br /> �i l)li�{�v I I U ���17C1 G�� U <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �5��(,���,n� I _Eleciric �Gas_Other � � �� � <br /> WORK DESCRIPTION <br /> ��i 5!A l� <3tt,n /��s�; 2 �� �irf/'/ac� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF FlXTUHE OR fTEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal � Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Wa�er heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Back(low preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Retrigeration <br /> Grease trap Woodstove <br /> Rool drains Other__ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> 1 hereby ceritily that I have read and examined this app6�ation and know ihe same to be troe and correct. AC provisions ol laws and <br /> ordinaces goveming Ihis type of work will be complied with whether specilied herein or not.The grentinp ol a permit does not presume <br /> to give autheriry to violate or cancel the provision ol any other state or local law regulaling construction or the pertormance of <br /> construction.That I am authorized by tne owner of this property to perlorm the work�or which application is made and I compty with the <br /> State Coniractors Law 1827 RCW and 296.200 WAC. <br /> � � <br /> ��,(% ilf // �i�� Q �21U � <br /> Signatur� nedConiractor/Authorizetl Agent Date <br />