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� <br /> � <br /> ,. <br /> PERMIT APPLICATION �,o <br /> CITY OF EVERETT PERMIT SERVICES �-� <br /> 425-57�8810D FAX 425 257 8857E www e e8retlwa.org �1���g� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 T'�7 <br /> SITE ADDRES PARCEL TAX I.D.N PERMIT A <br /> LEGA L T NO. BLOCK TRACT OR SUBDIVI910N/ <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �`�K L��C�JKLr <br /> �����'S yP✓i�C7"!l I �G��I TF�P! V��� „77CI lE�NIAIL ��'�G�/ �r�� <br /> � � � 1��'`t4�-' ��03 " O. <br /> CONTR.LICENSEN ��i / �,������ Lc��-� j�p/' ¢�- 3D3��0 <br /> u�F <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> C � Electric _Gas_Other .�( �(g� <br /> W�RK D�SC�`RIPT ON �� / _ _� /��y�� �/� G�-��. 7 �� <br /> G� �- �l��Gt',�°GC�p `'��� „� !�!/Si�aZ�C���;R/O �- T�'�C�f/C.� <br /> ✓�'� �cc ' <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handlirg units <br /> BathWb Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> _ Sink(service/bar/mop/etc.) � Exhaust fan CCJ�i�'C �- <br /> BackFlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinkinc�Fountain _ Boiler <br /> Floor drain Refrigeration <br /> = Grease lrap � Woodstov�.v���� <br /> Rooi drains Other C <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J106 <br /> I hereby ceAify that I have read and examined this application and know the same to be irue and correct. All provisions of lawa and <br /> ordinances governing this type oi work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel lhe provision af any other stale or local lew regulating conslruction or ihe performance of <br /> construction.That I am auth�rized by 1he owner of this property to peAorm the work for which application is made end I comply vrith the <br /> State Contracto�rs�Law ,2(7 R�C"and 29 . 00 WAC. <br /> %`��'G:�%�L /(/ C'�-- S'Z� �� <br /> Signature ot O er/Contractor/Authorized Agenl Date <br />