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PERMIT �l�PLI�A�"ION <br /> CITY OF EVERETT PE►�M17 SERVICES <br /> 3200 CEDAR STREET, EV�RETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —�vww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM v� �-C( —/(J <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � , J `J. �- ;;. ;T < ,.� - �IDvX - 0O(� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �����I�i,' ��L �(�t��', ��J�..:il.���j ��(��1 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITYIZIP PHGNE <br /> LL�- �t -�3 v��� j� �s- 'I <br /> L�;`i�, �� i�IV��'-���b�;r�l ��IO.A�qS 21 �f�'Gc�t� <br /> CONTR.UCENSE A '��,r I G � <br /> c� t�.q��C. w %r��,.,��� ��5� �3 7 <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> � O�Gt� ) Electric Gas Other <br /> WORK DESCRIPTION <br /> , .._1�{'. I�C, - �'r� l. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling uni�s <br /> ;-=> Balhlub Forced air syslems <br /> '�. I Lavatory�(wash basin) Gas piping <br /> 7 Showzr Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> '_�j_ Dishwasher _ Gas range <br /> Clothes washer Clothes dryer , <br />""� Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES YAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same lo be true a�d correct. All provisions of laws and <br /> ordinances governing ihis type of work will be complied with whether specified herein or nrd. The granfing of a permit does no!presume <br /> to give aulhority to violate or cancel ihe provision of any other state or local law regulating�.�nsWction or the performance of <br /> consiruclion. That I am autholized by fhe owner of this property to perform lhe work for which application is made and I comply with�he <br /> State Contraclors La�v 18 27 RCW and 296200 WAC. � � <br /> , % _-- - =_-_ �-�y�f�l <br /> <__ Signature o(OwnedContraclor/Aulhorized Aqent Date <br />