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PtRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.X PERMIT 11 <br /> � Q/ 1/�'V q� � � 7��� �� <br /> LC-GA LOT NO. BLOCK TRACT OR SUBDMSION R <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNONE <br /> , 1 1 � ^ � ' 1 1 <br /> TEN TNAME I CONTACTFORPERMIT PHONE ���_ ���L � 9y�7 <br /> _� <br /> 1 �L�� E�AAIL <br /> �•. w� � yas-?y3-a 73 <br /> D.�b� a Sm��. LI.C, C�n�.�cf�or 19�a Se crso,-.Wa.� �yn�wood <br /> corrTR.LICENSE N���� ��Tn <br /> � -nil �� �, <br /> USE OF BUILDING HEAT SQURCE CONTRACT PRICE OF WORK <br /> S� !� _Electric _Gas_Other �Lt� K <br /> h <br /> WORKDESCRIPTION Op�,'�nt.� , S�c���'� ���`f�-rS � C�.✓yWa�I <br /> PLUMBING MECHANI(:AL <br /> NO. TYPE OF FOCTURE OR ITEM NO. TYPE OF FIXTURE OR IiEM <br /> Toilet _ A/C -air handling units <br /> Balhlub _ Forced air syslems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower _ Walerheater <br /> Kitchen sink&disposal _ Gas firepiace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water healer Range hood <br /> Sink(service/barlmop/etc.) _ E�ausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> Drinking Fountain _ Boiler <br /> Floordrain _ Refigeration <br /> Grease lrap _ Woodslove <br /> Roof drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 <br /> I hereby ceritity thal I have read and examined this applicaGon and know the same lo be true and cortect. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied wilh whether specified herein or not.The granling of a pertnil does not presume <br /> to give aulhority to vioiale or cancel the provision of any other state or local law regulatlng constructlon or the pertormance o( <br /> conslruction.That I am aulhorized by lhe owner oi this property to perform the work for which applicatlon is made and I comply with the <br /> State Conlractors Law 18.27 RCW and 296.200 WAC. <br /> (���Q�,�,�,.___ �� �aq I o� <br /> SignaWre of OwnedContraclodAuthonzed Agent Dale ���7 <br /> s� <br />