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; <br /> P�RMIT APPLIGATIC�N <br /> CITY OF EVERETT PERMlT 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 �� _ �[� ,��-Y <br /> SITE ADDRESS I�%%� If PARCEL TAX I.D.f PERMIT# <br /> Y G� r <br /> _�l ) i " 7 { �� /ll4 �C. � � 11 - ��r GC'� "G'i�`.�f/]�1���!'ti.2CCY1,�.75iC' �� ��l-Uo7 <br /> �EGAL LOTNO. BLO�K TRACT <br /> 'JESC. <br /> OWNER , <br /> ADDRESS CITY2IP PHONE <br /> L��,� �%��� � �' C a <br /> -,�„(c � IG,?�-� ��-�JA�•c � iK ��� ff rG`�.�"� �/��-357'7yC0 <br /> TE�NAM�� � CONTACT FOR PERMIT PHONE <br /> /?r:� ,�.. �J iw, C•;/ln�'• /�iil �n=�/�c� J£ L +. 1 ` <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> C<Fr,..y �.��ti'�:..-�.�., - >i - s� <br /> i c� �� i9- ,�:,r � / <br /> CONTR.LICENSE# L � ���C� ��S �J 3l'1II7 <br /> GAifti' � Ti�� K� � l .: _ <br /> USE OF BUILUING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r^� <br /> ��,,_� //r�,f;�, �, _Electric L/Gas_Olher �% ��� <br /> WORK DESCRIPTION <br /> �1 <br /> PLUMBING MECHANICAL <br /> ry(, TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—:3ir handling units <br /> Bathlub Forr,ed air systems <br /> Lavatory(wash basin) _ Gas pipinp <br /> Shower Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasfier _ Gas range <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmoplelcJ _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woudslove <br /> Roof drains Other_ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhat I have read and examined this applicalion and know the same lo be lrue and correcL All provisions of laws and <br /> ordinaces governing this type o(c+ork will be complied with whelher speci(ied herein or not.The grenling of a permil does not presume <br /> lo give aulhority to violale or cancel ihe pruvision of any other slate or local law regulatircg construction or fhe performance ef <br /> conslruc' n.That I am autf�orized the owner of this property to pedorm lhe work for which applicalion is made and I comply wilh the <br /> Slale Co t aclors La� �18.^7 C nd 296.200 WAC. <br /> / <br /> `"�, /_ -�� <br /> SignaWr of Own dC ntre t thon ed Agent Date �� <br /> � <br />