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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 :,'�U(�F, _ 0:�� <br /> SITE ADDRESS , PARCEL TAX I.D.# P RMIT/{ <br /> � rnc <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OW ER ADDRESS CITY/ZIP PHONE <br /> ��C�7; iKv�r,�'� <br /> IGI NTNAME CONTAQ TFORPERMIT PHGNE [�(�3$✓7Sir•T� <br /> G ,p /y��,e ��,[/� <br /> G �/7/A!/���� • //U ����� E-MAIL <br /> LSc-U TRfiLSertC vY1�C.�ll� ll���I31 �L�� � � Y���/�`.�l5dl N '�'3'�t� � <br /> CONTLR.LICENSE if ,r, 'J!1 <br /> V���� �Y �w �� I <br /> USE OF BUIL�!`IG HEAT SOURCE CONTRACT PRICE OF WORK <br /> Q Q <br /> �n�/�K�s�/�T� • _Ele�tric _Gas_Olher l0�OQ� �' <br /> /TLiri TtF7r <br /> WORK DESCRIPTION <br /> �►�trnc4 �i92. l�'C�U��S��Da�GfS <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FI%TURF QR ITEM NO. TYPF OF FIXTURE OR ITEM I <br /> 'z Toilet _ AIC-air handling units <br /> 6athlub Forced air syslems <br /> � Lavatory�wash basin) _ Gas piping <br /> Shower _ Wa�er heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dper <br /> / Waler healer _ Range hood <br /> Sink(servicefbaNmopfetc.) _ Ekhaust fan <br /> Back(�ow prevenler _ Heat pump <br /> � Uri.�al _ Unil heater <br /> Drinhing Foimtain _ Boiler <br /> � Fluor Crain _ Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Oiher <br /> Olher __ — — <br /> CITY OF EYERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerility thal I have read and examined Ihis application and know the same to be true and correcl All pro�•isions of laws and <br /> ordinaces goveming lhis lype o(woik will b�complied wilh whether;pecified herein or noL The grantinq o(a permit does nol presume <br /> ito give authority te violale or cancel Ine provision o(any other stale or local law regulating conslruction or Ihe performence of <br /> conslructio Thal I am aulhorized by Ihe owner of this property to per(orm lhe work lor which applicalion is made and I comply wilh the <br /> Slale Con actors Law 18. F� VJ a�d 29u.200 WAC. <br /> 'S� Gi/�1�� �-� -o� <br /> , <br /> ��« <br /> �I Signalure of OwnerlCuniractor/Autf�onzed Agent Dale II <br /> �--_ - - -- —J <br />