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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT,WA 9820' <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED��ROM 8 M�l TO 4 PM 3�a) ,� � <br /> SITE ADDRESS � 5 rE ' PARCEL's'AX I.D.# PER T# i <br /> I o � i� ►�► %" A�Jc- sE.t I d�t � �,� � o�hr%5aro o � ��� ���� <br /> LEGAI LOT N/0�. / BLOCK TRACT UR SUBDIV,I�S^ION c#� �7 �y�� <br /> DESC. L' "1 '1 �I���=IL— l�T��C I�I e�-) / I�?I�.F� <br /> ���,�/�. v�j/�F ✓IGI�IU, LL�— ADDRESS CITY2IP PHONE 425—?j�7�T� <br /> s'i��-�`C �/J v�C GR 1 c�/l� r2£�/�,,�.'- SC; �TC- /tY> EG�%'c-;� . 9��'-f�� <br /> TEN T NAME CONTACT FOR PERMIT PHONE <br /> IVI � E-MAIL <br /> �p D I I P <br /> Ct i ACG�iJ>Tr�tl�c 403 �Nfb�� '-'�, TE � SiUJH0l�1/Srl �J0�71 <br /> CONTR.LICENSE# J- , I _ U(j 3 ��, —�S —1 8 =� / <br /> O <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other �7'3 S <br /> WORK DESCRIPTION <br /> � <br /> ��� u ` c ��__�L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas p!ping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes wasi;or Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Back(low prevenler Heat pump <br />, ^ Urinal Unit heater <br /> Drinkiny Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease�rap _ Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAti CODE IS 3105 <br /> I hereby cerili(y lhat I have read and examined lhis applicalion and know the same to be true and correct. All provisions of Iaws and <br /> ordinaces governing this lype of .vork will be complied with whether specified herein or nol.The granting of a permit does nol presume <br /> to give aulhority to violate or cancel the provision of any other stale or local Iaw regulating construc6on or the pertorrrance of <br /> construclion.That I am aulhorized by lhe owner of this property to.peAonn lhe work for which application is made and I r.omply wilh the <br /> Stale Contractors Law 18.27 RCW a�nd 296 200�WAC. % / <br /> �-_ ,� <br /> '----, ��i-E�I ,_.�, Lc� � 3, 7 ! ;� <br /> �SignatJe Owner/ nlract Au orized enl Date <br /> � - � 'Iz <br />