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l <br /> PERM�T APPLICATION <br /> GITY 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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> i/ 8/ l�rN f�U� .St' �70 — <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIYISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> C�O�}�� � S�'/2ff�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR �pDi�[Ia�� L�°•^O���f ADORESS � /�Y CITY2IP PHONE <br /> zJ7ds iz�� ?Go-yo,7+�74��1 <br /> CONTR.LICENSE# E7UQlr 1 l�J�c�G Z7�-C Z- �2L �K j %�ry� liy¢-S F�Z L � <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas_Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> f Toilel A/C–air handling units <br /> Balhtub Forced air syslems <br /> � Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Back(lov✓preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> � Roof drains _ Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and know lhe same lo be true and correct. All provisions of laws a�d <br /> ordinaces governing this type of work will be comp!ied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel lhe provision o(any other state or local law regulating consWction or lhe performance of <br /> construction.That I am aulhorized by the owner of this property to perform lhe work for which applicafion is made and I comply wilh the <br /> Slate Contre lors Law 1fl ?RCW and 296.200 WAC. <br /> / <br /> i/1�����_ � 5- �C�-c�-� <br /> S gnature o(OwnadContractor/Authorized Agent Date <br />