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P�r�MIT APPLICATIG�J <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 NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT# <br /> � � 3 y Lo��c�z � „��� a v _� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. /�� <br /> OWNER ADORESS CITY2IP PHONE <br /> f-1 �r7-i �Z L:7.-'iL�Zi�J2 (Sc= 5 <br /> TENANT NAh1E CONTACT FOR PERMIT PHONE <br /> CONTRACTOR �J ��h,.S Uti �� ti,G, ��„L AODRESS CITYRIP PHONE <br /> CONTR.LICENSE# `� �3� U �? �/�7� /1 �t .�-� �}-�1�. '^a.c'^' 3 vo � Yo 1 7VE <br /> 2G�f3/N� �772GL `��2Zj <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> S �j2 Electric Gas Other ��'U G <br /> WORK DESCRIPTION <br /> / /.J S /A"L., f-//2t. SI�A1(AKLC7ZS �N F� C'�"`" � f-fZ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC-air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&dis{.�sal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Ctothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> BackOow prevenler Heat pump <br /> �� Unnal Unit heater <br /> � Drinking Fountain Boiler <br /> I _ Floor drain _ Refngeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> ; Other 1(Q NcN-�4 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � I hereby ceritify that I have read and examined this application and know the same to be t��e and correct. All provisions of laws and <br /> ordinaces governing this type of wod;will be complied with whether specified herein or not The grenting of a permit does not presume <br /> � to give authonty to violate or cancel the provision of any ether state or local law regulating construction or the performance of <br /> conswction.That I am authorized by the owner of this property to per�orm ihe worA for which application is made and I comply with the <br /> State Ccntractors��La'" 18.27 VJ and 298.200 WPC. <br /> I 1-�(� �/�.� � r �s/o y I <br /> Slgrfature oT'0 �nenContractorrAuthonzed Agent Date <br />