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I�Et�IVIIT APPLlC/�TI��V i <br /> CITY OF E'JERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-8810- FAX 425-257-SR57 -www.Pverettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �ARCF_L TAX I.D.# PERMIT# <br /> /�o / y y�� ��` S� �fY� U� ra-o�(a <br /> LGGALI LOT NO. BLOCK TRACT OR SUSDIVIS:ON p <br /> DESC.� <br /> QWNER ADORESS CITY/ZIP PHCINE <br /> h y2s-3 y8'- 9 z�o <br /> ',7' "1 ✓o�y l, e ��`Y /.�O/ y y7-�, -5•��'" ���gy, = r rt z z z <br /> 1'[NANT N— AM�--� CONTACT FOR PERMIT PHONE <br /> �/ t Jr{�: �; �� �S vzs- �o8-G�/� � <br /> I !� n C{��� E•MAIL <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> I Ey/u., �/.,-- f�/ti � 5<<-� z.,�- 3.�o i ����� ,,�z�-zs-`i -z/c � <br /> COIlTR. LICcNSE# � tjp.�/ <br /> �3�L✓9�✓S.5 o42 /SL L�uG>t � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WURK <br /> �J / Q o v <br /> /'( rs -- �j� ]L _Eleclric �Gas_Olher (p � (' <br /> WORK DESCRIPTION <br /> / ; � � ` E/ O / /Y'� <br /> PLUM[31NG MECHANICAL <br /> NO. TYPE OF FIY,TURE OR ITEM NO. TYPE OF FIXTURE OR ITEIA <br /> Toilel A/C—air handling unils <br /> BalhWb Fcrced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disp�sal Gas(ireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(serviceNar/mop/elc.) [xhaust(an <br /> 6ack(low preventer Neat pump <br /> Urinal Unit heater <br /> Drinking Founlain � Boiler <br /> Floor drain _ Refrigeralion <br /> Grease irep Woodslove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this applicalion and know Ihe same to be irue and correct. All provisions of laws and <br /> ordinaces governing this rype of work will be wmplied wilh wheiher specified herein or nol The yranting of a permit does nol presume <br /> to give authority to violale or cancel the provision of any other state or local IaN regulating construction or the performance of <br /> construclion. That I am aulhorized by lhe owner o(lhis property lo perform the work for which application is made and I comply with lhe <br /> Slate Contrac Law 18.27 R W a 296. 00 WAC. <br /> ���/!//l�L-'€�� �z�Z�—D 7 <br /> Signature of Owner/ ontraclodAuthorized Agent Date <br />