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• <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 /> SITE ADDRESS PARCEL TAX I.D.# PERMIT` # ^/f <br /> a.7-�i ?k SC OoS7 /toa�oo� S�J � J/2 G� <br /> LEGAL t OT' -OSI(' BLOCK TRACT <br /> DESC. 1-{"S <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> C�►n s C Imo.-. i L t - f a�-t-�.. Plkce Si: �.* Lias• 31)-S--)‘n <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �� <br /> .2.16t-.4-t‘(1 <br /> (�� <br /> CAAAN-` CiCL C�l ri3 �R l�¢ 4 d C-3 37-.C-2‘n Ci f) <br /> CONTRACTOR M.o. ADDRESS CITY/ZIP PHONE <br /> ' `;`1 .2- I7-44 4.4 uw Se.4_4(24. 418117 010 6 - 3 alt-609 <br /> CONTR.LICENSE# INA OSo P1 W <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> '—. p _Electric .7 Gas_Other 7 SJ vs-z) <br /> WORK DESCRIPTION I �4 <br /> bcA<oa•...s .4- <br /> 172 e6V 1 -x-97, ' - <br /> PLUMBING MECHAN AL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> I Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this 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 of any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Signature of Owner/Contractor/Authorized Agent Date �/ <br />