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F �RMIT APPLICATIuN � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CF.DAR STREET, EVERETT, WA 98201 <br /> 425-257-881(,— FAX 425-257-8857—www.everettwa.org <br /> 6 - �6 - oS <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> / /O �Z f� � �r/I /!v-C ,S'E' XC�SOCo -005 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> C0�9- S i n- S' G�17 f/�-C <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR �QQI�(f� ��U nr(//<y ADDRESS CITY2IP PHONE �z,� 7 <br /> z /C.�'� �L�y�//�Ilr /r���l� `f <br /> CONTR.LICENSE# <br /> /��!l�af7�n� � f'zZ� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���( �G�� f _Electric _Gas_Olher � �..�> <br /> . <br /> WORK DESCRIPTION <br /> ��Ll fsa 6�i� „ <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> a-/ ' Toilet A/C—air handling unils <br /> IBalhtub _ Forced air systems <br /> _[ f_avatoiy�.•ash basin) Gas piping <br /> Shower � Waterheater <br /> � Kitchen sink 6 disposal _ Gas fireplace <br /> Dishwasher _ Gas ran�e <br /> Cbthes washer Clothes dryer <br /> Laundry tray Range hood <br /> 1_ Sink(service/bar/mop/elcJ _ Exhaustfan <br /> Backflow prevenler . Heat pump <br /> � Urinal _ Unit heater <br /> _� Drinking Fountain _ Boiler <br /> �_ Floordrain _ Refric�eration <br /> Greasc lrap Woodstove <br /> �" Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined this application and know the same to be We and wrrect. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whether speciTied herein or not.The granting of a permit does not presume <br /> lo give aulhority to violate or cancel lhe provision of any olher slale or local law regulatiny conslruc6on or the performance of <br /> wnstruclion.That I am authorized by lhe owner o(lhis property to pedorm the work for which applicatlon is made and I comply with lhe <br /> State Conlractor�aw 18.2�CW and 296.200 WAC. <br /> .,! <br /> ��/ �:t <br /> u�v I <br /> Si n ture of Owner/ConlractodAuthonzed Agenl Dale <br />