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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-6810— FAX 425-257-8857—www.?verettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM � "�'� ��v <br /> SITE ADDRESS PARCEL TAX I.D.k PERMIT N <br /> l5 SH = �uE ' q �� � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRE55 CITY/ZIP PHONE <br /> � r �� �= G,� an s 3a �s s�Q� w�c EVEr�-r <br /> TENANT NAME CONTACT FOR PERMIT PHONE �S3 �/� 7�S <br /> �FF �' , zS6 S I �Re� /� �ax� t�c--R e�ni� E <br /> �pAaN <br /> �a �S([,1I�7CK C.On1rRACTCRS �� PO 130X 2S?�I K•x4K�nwJ v�/A <br /> CONTR.LICENSE N <br /> aS��,� �_ �, <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eledric _,Gas_Other � QOO.00'� <br /> WORK DESCRIPTION <br /> RI:C�cArT.c„•1 p h= A l���C T� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURC OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet _ l4'C—airhandlingunils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _. Gas firepiace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Waler healer _ Range hood <br /> Sink(service/badmop/etc.) _ Exhausl Fan <br /> Backflow prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Foun�ain _ Boiler <br /> Floor drain _ Pefrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby certify that I have read and examined lhis appiication and know lhe same to be true and correcl. AII provisions of laws and <br /> ordinances governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to giea authoriry to violate or cancel the provision oi any other state or local law reguiating construction or the pedormance of <br /> construction.That I am authorized by the owner of this property to pertonn the work lor which application is made and I comply with the <br /> State Cont��s Law 18.27 CW 296.200 W <br /> �fZ✓� � -� ��31�1� <br /> Signature oi O edC niractor/A honzed Agent Dale <br />