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P�RIV�IT APPLICATIVN <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 �3 _�O —07 <br /> SITE ADDRESS PARCEL TN(I.D.# PERMIT# <br /> 1 � .S Q Cl �� ��C1t Stf r ' . <br /> LEGAL LOT NO. BLOCi. TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �ePle� �t� <br /> TENANTNAME CONTACTr'ORPERMIT PHONE <br /> �r�--(m-, �'/Z�� <br /> CONTRACTOR �Q�p���-�7 P`���Q�tC�ADDRESS CITY2IP PHONE <br /> �LZ�O -(L��vc�rr l�.rc�K,��, <br /> CONTR.LICENSE#�obr�r P.�-z7 zC' z.- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other �/� O-fl' <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel AIC—air handling unils <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer _ Clothes dryer <br /> Waler heater Range hood <br /> Z Sink(service/bar/mop/elc.) _ Er.'iausl fan <br /> Back(low preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refngeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhal I have read and examined this application and know lhe same lo be lrue and correcL All provisions of laws and <br /> ordinaces governing this lype of work will be complied wilh whelher specified herein or not.The granling of a permit does not presume <br /> to yive authoriry to violate or cancel the provision of any other slale or local law regulating wnslruction or lhe pedormance of <br /> conslruction.That I am aulhorized by the owner of lhis propeRy to periorm lhe work tor which application is made and i comply with ihe <br /> Slale CoNr ctors aw 1 . 7 RC nd 296.200 WAC. <br /> % �� Z�� -� 7 <br /> SignaWre of Owned onlraclodAulhorized Agenl Date <br />