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P�RMIT APN�ICATI�N <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 32Q0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> �� � �;�f�� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> /�zi �rs'� � �-� �w�.,� -- — KcSci-va7 <br /> LEGAL LOT NO. BLOCK TR/�.CT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ���.�C�' �//-�'n y <br /> TENANT NAME CONTACT FOR PERMIT H��.1.f:� z PHONE <br /> �%�+ ��Q���:-, �1 z�— L G.F �ri% <br /> CONTRACTOR �Q�.Q_ �„-t ADDRESS ���-2 �ic5'du•/� CITY2IP PHONE I <br /> 42/` <br /> CONTR. LICEN°E# <br /> f U� L��� LC�,.>S�/� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'��S /_ _Eleclric �Gas_Other <br /> WORK DESCRIPTION <br /> ���� �;�j� sys�P�.. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIYTURE OR ITEM I <br /> Toilel A/C—air handling units I� <br /> Bathlub Forced air systems I <br /> Lavalory (wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink (service/badmop/elc.) Exhaust fan I <br /> Backilow preventer Heat pump <br /> Uri�ial Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> 011ier <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examired this application and know ihe same lo be true and correct All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specilied herein or nol.The granting of a permil does not presume <br /> to give aulhoriry to violale or cancel the provision of any olher stale or local law regulaling construction or the performance of <br /> construclion. That I am aufhorized by lhe owner of this property to peAorm lhe work for whlch applicalion is made and I comply with t�tie <br /> Slate Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> .,� 7 /�'/1`. dl'_ <br /> Signature of OwnedConlractodAuthorized�genl Date <br />