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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 4?5-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACV�PTED FROM 8 AM TO 4 PM <br /> SIT�ADDRESS I U I 4 ��� �Vl. S� � �� PARCEL TAX I.O.# PERMIT# _ <br /> Qi1'� • �- °l$ Zo S <br /> LEGAL LOT NO. BLOCK TRACT �E O !„D� _��I <br /> DESC. �� <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �ia.�� (��.,fiy �'n u� �e�,«;{c,r-N��u..,�,�. 2ob_2sv =�a4� <br /> CONTRACTOR �� (��Y� G 1 J (u�p ADURESS ��n, S 2�'C+,nL��7/ . (,��� A��'�// (�C) <br /> � J 7 � � n �-b J I" � �-N � 70 0 d <br /> CONTR.LICENSE�Y S� '�IV(�(�'� � '-"'I�d .�-�,�.�I W l� <br /> ����4,�2/�zoZ� ',�'j �j Yw3 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />� _Electnc _Gas_Other � `1 �0� � � �� <br /> WORK DESCRIPTION <br /> 1,,� �,l I �'���.. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. I TYPE OF FI�(TURE OR ITEM <br /> Toilet A/C-air handling units <br /> BathWb Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drein Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9106 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and corcect. All provisions of laws anZ <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The grenting of a pertnit does not presume <br /> ro give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> constructio hat I am authorized by the owner of this property to peAorm the work for which application is made and I comply with the <br /> State Con�tact r aw 18.27 CW and 296.200 WAC. <br /> '�� � ��� . � �� <br /> Signature of Ow er Contractor/Au�hd;i ed Ag nt ate �IL <br />