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�--1 <br /> 1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—vwvw.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM g —a�j�0 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �i9 (�•7� S�' y�L`'l O 'D� <br /> LEGA LOT NO. BIOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> ONMER ADDRESS CITY2IP PHONE <br /> �v � f�Ma� , �Ir'� r�� <a- /��„�+� N� 9s�� tiu_3a��o,� <br /> TEN NT NAME CONTA T FOR PERMIT PHONE <br /> E•MAIL <br /> �9�'.26� ��-�,�1.. G� � <br /> CONTR.LICENSEq �r���Z1Q,r <br /> SQ� �S fLC i�^-i�V�+.� IL.A !�-� d�. � 1 <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric �Gas Other � �Ut�Q Ud <br /> � <br /> WORK DESCRIPTION <br /> �K f'i ACc.. (A���`'a.�✓ �.���..�.. � -d.i/✓`�t L <br /> PLUMBING MECHANICAL <br /> '�O. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A!C–air handling unils <br /> Bathtub ,�_ Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower � Water heater <br /> Kitchen sink &disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink (service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify�hat I have read and examined lhis application and know lhe same lo be irue and correct. All provisions of laws and <br /> ordinances governing this type o(work will be complied wi�h whether specified herein or not.The granting of a pertnit does not presume <br /> lo give authority to violate or cancel Ihe provision of any other slate or local law regulating conslruction or the pertormance of <br /> consiruction.Thal 1 am authorized by�he owner of this property to periorm lhe work forwhich application is made and I comply with the <br /> State Contractors Law 1827 RCW and 296.200 WAC. <br /> ��� �--- - .�/z 5/�'`� <br /> SignaWre o( ne�STraclor/Authonzed Agent DaleT— <br />