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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 I <br /> SITE ADDRE55 PARCEL TAX I.D.# PERMIT# <br /> �6zr L/l � sT aoSnLlo1 �o � � el SC�S� ( -C �Zi <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRE55 CITY/ZIP PHONE <br /> � f'T� !, L'VG� 4�M��� �O�Z C1�� ,T�l. S��NT �Cliti�T� <br /> TENANTNAME CONTA FORPERMIT PHONE <br /> �� CU �s�4 I Sfc�� f[o sL, Njs� 77L b'S' 3.y_ <br /> CONTRACTOR � ADDRESS CITYIZIP PHONE <br /> r!y iVccv <br /> � �< <1 �� <br /> CONTR.LICENSE# 7y�� `� �� � �7� 77�' k � �^ <br /> /,3ci��.n. cc77ci., rcve.�/# c.h ��zo:5 <br /> USE OF BUfL01NG HEAT SOURCE CONTRACT PRICE OF WORK <br /> Y�gEs .,.�h.,�r _Eledric _Gas_Olher -1 Z� 71� � �G <br /> WORK DESCRIPTION <br /> / /` // ! / i <br /> / v��i+GC. lZ� Si�4J�c �t�4c1_J' S�.J,v L�.Si,a..FS v�.� [K ��r�� b /�i'�` <br /> PLUMBING MECHANICAL <br /> N0. NPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling unils <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping � <br /> Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas renge I <br /> _ Clothes washer Clothes dyer <br /> _ Laundry tray Range hood li <br /> Sink(service/badmop/etc.) Exhaust fan I <br /> _ BackAow preventer _ Heat pump I <br /> Urinal Unit heater � <br /> Drinking Fountain Boiler I <br /> _ Floordrain Refrigeralion <br />� Grease trap Woodstove <br /> Roof drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 ' <br /> I hereby ceritify that! have rE�d and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not. The grenting of a permit does��ot presume <br /> to give authority to violale or cancel the provision of any other state or local law regulating construction or the perfortnance of <br /> conslruction.That I am authorized by the owner is propery to pertorm ihe work for which application is made and I comply with the <br /> Slate Contractors I.aw 1 RCW � PcC-- <br /> ="' <br /> Signah�re o w /Contractor/Authonzed Agent Date 1/ <br /> � <br />