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P�r2MIT APPLICATIGi� <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 - DEBIT& CREDIT CARDS ARE N07 ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �s ��y �nv�� ,�,��:r ,e� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DES0. y <br /> OWNER ADDRESS CITY2IP PHONE <br /> A�c7A�2 L�7t.Z'17iA�Sc�' <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CIN21P PHONE <br /> �J,9iuSo..i /'iii�C^ . /..-C 1�33u /��/ni Avc .1.� �0-.2�irGN� <br /> 36x7 - YU3 -7�F62 <br /> CONTR.LICENSE N 9�L� 3 <br /> 20/�J�N��E 27LC Z <br /> USE OF E:1ILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S ri2 _Electnc _Gas_Other �6- S3�v <br /> WORK DESCRIPTION <br /> /�Ci $ ila-tti /�/�f- $/J2in-/lcG7?S /�./ .tJC�'v S �7Z <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <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 /> Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> Backficw pr?ventcr Heat pump <br /> Unnal Unit tieater <br /> Drinking Fountain Boiler <br /> I _ Floor drain _ Refngeration <br /> Graase trap Woodstove <br /> _ Rwf drains _ Other <br /> Other_ <br /> '� f� i tf.�A�7 C <br /> � <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> , I hereby ceritify that I have read anc ezamined this application and know the same ro be true and correct. All provisions of laws and <br /> I ordinaces governing Ihis type of woric will 6e wmplied wiih whether spec�5ed herein or not The granting of a permit does not presume <br /> � to give authonry to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> � construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> �� Slate Contr2ctors La`��18.27 R and 296.200 WAC. <br /> / <br /> ,4-�1--� � I /�r ��-`7 <br /> SignaNre af wnevContractor/Authonzed Agent Date <br />