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� <br /> PERMIT APPLICATION <br /> C17Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICpTIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.p � PERMI <br /> i�oas t5T ��e SE o03915000038002 yv1 �� o - �L, <br /> LEGAL LOTNO. BLOCK TRACT <br /> �ESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> AAQOr.I A�LSAVEfZ l��aE lcY 'brZSE E�/EfZ� �SS- 355-9�a-`A <br /> TENANT NAME i CONTF.CT FOR PERMIT PHONE <br /> g HAwra�a�.1 au�►� ao�-a�-e �`�`�ao <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> B�2ENr.lAT�I Nt.A"Ct�.lf��qJ� �{�ot S i3�-�.'� �����a q&�t�P <br /> CONTR.LICENSE fl���������t��.^ ��,�-a�,Q•�Q D� <br /> _ � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S� � I _Electnc X- Gas_Other �p��� <br /> WORK DESCRIPTION <br /> ,� �sia� C�S F��r IAcE k t�u�T �JIErAS �i����'i�b�o��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub � Forced air systems <br /> Lavalory(wash basin) ,� Gas piping <br /> Shower I Water heater <br /> Kitchen sink&disposal _ Gas 5replace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust lan <br /> BackFlow preventer Heat pump <br /> Unnal Unit heater <br /> Dnnking Fountain Boiler <br /> Floor drain Refngeration <br /> Grcase trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1705 <br /> I hereby ceritify that I have read and examined this application and know ihe same to be true and wrrecl All provisions of laws and <br /> ordinaces goveming this type of work will be complied�vith whether specifed herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> wnstruction.That I am authorized by the owner of ihis propeAy to perform the work for which application is made and I comply vnth the <br /> State Nractors Law 182' W and 296200 WAC. <br /> .� Q�.�� �al��-/os <br /> Signature df Owner/CoNractoqAuthoraed Agent DatA <br />