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P�'KMIT APPLICATIOIv <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 <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT# I� <br /> l 0/ fl �„ /� �Ft�S oo yoo -, � <br /> LEGA LOTNO. �OCK TRACT <br /> DESC. J�+c r! : �� <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> L'�o� s�p l s�f�o� F'o �x �3�'3 , y k�t u��., g��'o� -�3q3 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR / ADDRESS C�I v21P PHONE <br /> (�Jc �n;'� Cc,�S jOf/) 19� c SLl [:,,E'r�� y,?5`3�`rrl--?/l�l <br /> CONTR.LICENSE#GA��� /Quk3 <br /> / <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> p / <v <br /> /���Y�rn � . _Electrir, _Gas_Other ���p� .•— <br /> WORK DESCRIPTION �G 1� <br /> TT�I� ���/i� /�oCt.� 4 �+f is 1�.� Wi Ir �( �-'�C.✓ �Y ��w(.77� <br /> V <br /> PWMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> 8athtub Forced air systems <br /> Lavatory(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(low preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains O�her <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this appiication and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governing lhis lype o(work will be complied wilh whelher speciTied herein or not.The granting of a permit does not presume <br /> lo give authorily lo violale or cancel ihe provision of any olher stale or local law regulaling conslruction or the performance of <br /> co Eruction.That I am a ,ori ed by ihe owner of this property to perform lhe work for which application is made and I comply with the <br /> Sta Contracrors La ' 18 C nd 296200 WAC. <br /> l.' f 1 <br /> SignaWre of edContr ' /, ho zed Agent Date <br /> U, <br />