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PtRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA !38201 <br /> 425-257-8810– FF,X 425-257-8857–www.e�ere?�wa.org <br /> % � / — APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCE�TAX I.D.# PERNIIT R <br /> 3�(-3sis S � � x�'x%�=�co`' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. I <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ft��G �'/l� s�lc��S7"r�t� — <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR � ADDRESS CI 21P PHONE — I <br /> �Swr�niSoK mr�c�� llvg3i I'1'Ie,�a� RD �� S�Z�=3�T7� 7 <br /> CONT .IICENSE# 9.g�23 <br /> ..�wa��rr /s2 r.��4 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRQIlCpE OF WORK <br /> _Electric _Gas_Olher ��Qfl � <br /> WORK DESCRIPTION � <br /> ����� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR I'iEM <br /> � Toilel _ A/C—air handling units <br /> [3athWb Forced air systems <br /> �_ Lavatory(wash basin) _ V�S P�P��9 <br /> Shower Water healer <br /> � Kilchen sink 8 disposal _ Gas firepiace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbadmop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refric�eralion <br /> Greasc lrap Woodslove <br /> Rool drains _ Olher <br /> _Z� Other���RT�. _ <br /> CITY OF EVER[TT LOCAL SALES TAX CODE IS 3�05 <br /> I hereby cerili(y thal I have read and er.amined Ihis application and know the same to be true and correcL All provisions of laws and <br /> ordinaces governing Ihis type of work will be complied with whether specified herein or not.The yranting o1 a permil does no�presume <br /> to give aulhority lo violate or cancel lhe provision of any olhzr state or local law regulaling wnstruction o�ihe pedortnance of <br /> r.onstruction.That I am aulhori �d by the nwner o(�his properiy fo pedorm tho work for which application is made and I comply with the <br /> State Con aclors Law 1827 and 2E620U WAC. <br /> , ni �� 8•30�oS' <br /> Sign fure of�wnedConUactonAuthonzeA Agent Date <br />