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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SI7E ADDRESS PARCEL TAX I.D.# PER T M O <br /> �oq,� � � s� �03� i� �000 aaoo o.s .3/ <br /> LEGA LOT NO. BLOCK TRACT OH SUBOIVISION N <br /> DESC. <br /> OWNER ADDRE55 CITY2IP PMONE <br /> ,�(i C..�.'i c �a,,,,i o r i o q�S f r�1! S6 �i��r,�'�ti' <br /> TENRN7NAME � I CONTACTFORPERMIT PHONE <br /> E-1�7AIL <br /> 4>LuEF�.ArnF_ ��t, �1�1(n22c� Sl .Sw yl mo�ntloYeitriu�c �iBU`I� 4�-5-'��r7i39 <br /> CONTR.LICENSE A' <br /> 6L�E F 1.i'��l'7 2� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WOHK <br /> v'� <br /> Electric Gas Olhcr (f�� s '"' <br /> WORK DESCRIPTION �' / � , , [ � L / , �� ' <br /> /it!j v7�C� �Gc�,�ld5'S i�x.a�� /J-y,.� , h1 i�,5 v,,r, s 7 <br /> F6 f Pv� /�i�e `ro�ra-,r, . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUHE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink 8 disposal _ Gas lireplace <br /> Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Watcr heater Range hood <br /> Sink(servicclbar/mop/cic.) Exhausl lan <br /> Dackllow prevenlcr �, Hca�pump <br /> � Urinal _ Unit hcator <br /> __ Drink�ngFounlain Boiler <br /> Floordrain _ Refrigeration <br /> Greasc trap _ Woodstove <br /> .= Fiool drains — _ Olher I <br /> Oihcr _ — <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 31D5 <br /> I hereby ceritity that I have read and ezamined lhis application and know Ihe same to be true and cortecL All provisions ol laws and <br /> ordinaces governing Ihis type ol work will bo complied with whelher specitied herein or not.The granling of a permi�does no�presume <br /> lo give aulhority to violate or cancel Ihe provision ot eny olher state or local law regulating conslruclion or the perlormance ot <br /> consuuclion, am uthorized by the owner ol this propeny to perform tho work for which application is made and I comply with the <br /> Slatc Cont ctors Law 0.27 RCW and 296.200 WAC. <br /> .� 3 0�. <br /> Signature OwnedConlractodAuthorized Agent Data <br /> I <br />