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( i <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.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D./ PERMIT It� <br /> �02sn�.c-�r/4V� L10�1.3��/�'� yQl3UU �OD�CJ/ <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION�I <br /> DESC. <br /> OWNER � AODRESS CITYILIP PHONE <br /> �z ��t'�el/ �/�/L �j`)ul ��`'�'>t- �V� �✓P'�77���zG/ 4�Z.S�ZB ��'37z <br /> �iE7NANTNAME pCONTACTFORPERMIT PHONEy�3�, ,�� <br /> //iL �✓�3�:���/.a, (� /K'?�r-'"_r�, �j �n e�a�,Pnn�''��.n.�naccls;r�r.�c lc.., <br /> �xtr.��� /+GClnnic��( �jv%c�f/C17S 232G; -!2� Sri9vC y7_�3�'Z�3U <br /> CONTR.LICENSE N <br /> �o���vi�r�, � �i5 1 Cz7- ,�e, �v��e7� �Blo.S <br /> USE OF BUILDING HEAT SOURCE I CONTRACT?RICE OF WORK <br /> C7U <br /> ��r,� ;� XElectric _Gas_Other �>��Q• <br /> WORK DESCRIPTION <br /> 1,�����.r� � c�,� r��<< � ���, -�,�r:f !�-/c G/,,. �- l--'.� ��� C��•��. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced 2ir systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kdchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(servicelbar/mop/etc.) _ Exhaust fan <br /> BackAow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trzp Woodstove <br /> Roof drains Other_ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby certiry that I have read and examined this application and know the same to be true and correcl All provisions of laws and <br /> ordinances goveming this type of work will be complieA with whether specified herein or not.The granting of a pertnit does not presume <br /> tu give authonty to violate or canYl the provision of any other state or local law regulating wnstruction a the performance of <br /> construction. That I am authorized by the owner of this property ro pertorm the work for which applicahon is made and I comply with the <br /> State Contractors Law 18.37 RC�V and 296,200 WAC. <br /> ,�-_, , '�-, <br /> �, �� /6 t 4%Ci / <br /> I � Signature o(Owner/ContractodAuthonzed Agent Date � <br /> Z <br /> � <br /> �_ <br /> � <br />