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( <br /> PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES , <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8610— FAX 425-257-8857—www.everettwa.org <br /> APPLICPTIONS ARE ACCEPTED FROM B AM TO 4 PM S_�-�`�� <br /> SITE ADDRESS PARCEL TAX I.D.if PE MR• <br /> � l i� ���5 - ��C° <br /> LEGA LOT N0. BLOCK TRACT OR SUBqN310N R i <br /> DESC. � <br /> OWNER ADDRESS qTY(LIP PMONE il_LS � �I <br /> CJ� JL / �{Pr.v C� 32v O C1 f!�✓ ��' �.C'.��tl�c(�ZJ) Z.S^7 -8�1 ti <br /> TENAN NAME CONTACT FOR PERMIT PHONE��v �7v —��'�I <br /> �l(� � CL` E�IAAIL ' <br /> u.k.S�s �e�-s, �►�.� p� �� ��c• px,�,,l i� 3c� 7Ss <br /> CONTA.UCENSE R D��S����) �8 3 �S S S '� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I �Electric �Gas_Olher I � •� S 7 Y �O <br /> i <br /> WORK DESCRIPTION , I <br /> �S - G�J�-�wa;� � on Qv�S�-���j � vA � e���P�u,r�- I <br /> PLUMBING MECHANICAL I <br /> N0. TYPE OF FlXTURE OR 17EM NO. TVPE OF Fl%TURE OR ITE61 � <br /> Toilet _ !UC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater I <br /> Kitchen sink 8 disposal _ Gas fireplace ,I <br /> Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood I <br /> Sink(servicelbar/mop/etc.) _ Exhaust fan I, <br /> Backflow preventer _ Heat pump I, <br /> Urinal Uni�heater � <br /> Drinking Fountain _ Boiler <br /> Floor drain Relrigeration , <br /> _ Grease irap Woodstove <br /> Roo(drains � Other � • �*+�K <br /> _ Oiher — ' . I <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS 3105 <br /> 1 hereby ceritify that 1 have read and ezamined this application and know the same to be true and correct. All provisions of laws and I� <br /> ordinaces govern�ng ihis type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision ol any other state or local law regulating construction or the performance ot <br /> consiruclion.That I am authorized by Ihe owner oi this property to perform Ihe work lor which application is made and I comply with the , <br /> State Contrac rs Law 78.2 R rN 296.200 WAC. ! <br /> � <br /> C � � -4-rl <br /> Signature of ...+ned ontra tori uihorized gent ate <br />