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, <br /> 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.everettwa.org <br /> , APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> I SITE ADDRESS J PARCEL TAX I.D.# PERMInT S �7 <br /> � Fj ��':.'c I ! G I-L I .1/ �C��C% " !� <br /> LEGA �LOT NO. BLOCK TRACT OR SUBDIVISION�I <br /> DESC. <br /> OWNER ADURESS CITY/ZIP PHONE <br /> rf � �\ C , cl , ;� `� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ' �� < M �\ -Prc�r � E-MAIL Z31 `fYCI <br /> A � DR PI 1 <br /> .J �r � S�•��s <br /> G:�,�TR.LICENSE M i — y�.�y- / /� <br /> �i k So N x'�0�2 C�r �F.� J2 Z / <br /> USE Oi� BUIIDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCF'.IPTION � <br /> j C c`r � G, �.,� rQii-cty C <br /> I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handliny units <br /> DalMub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water hea�er <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gar range <br /> Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> BackOow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Doiler <br /> Floor drain Refrigeralion <br /> Grease Irap Woodstove <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALE3 TAX CODE IS 3705 <br /> I hr.reby certify�hat I have read and examined this application and know the same lo be true and correct. All provisions oi Iaws and <br /> ordinances govemmg this type of work will be complied with whether specified herein or not.The grantin�ot a permit does nol presume <br /> to givc authority�o viola�e or cancel the provision ot any other s�ate or local law regula�ing consiruction or Ihe performance oi <br /> construction.Tha! I am au�horized by the owner of�his property to perform the work for which application is made and I comply wi�h the <br /> Slate Contractors Law 18.27 RCW and 29G200 WAC. <br /> , ;� ; � ��/�liv <br /> ..k.;� i, �<-r t- •-.-,� <br /> Signatwe of GwnedCenlractor/Auihonzed Agent a�'�— <br />