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rERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREP , EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> Q APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESSr��,SE ooY�/�o�0003oy �M��//` 0l3 <br /> LIIEGGAL LOT NO. BLOCK TRACTOR SUBDIVISION II /( <br /> GESC. 0rq t QI AGI'e 5 <br /> OWNER ADDRESS CITY/21P <br /> PHONE <br /> ���� �o I�e `� ��� S�3 P15� �,r•1�fi� aa3 995-P . ? <br /> TENANT NAME / I —� CONTACT FOR PERMIT PHONE q95- aq3 Coo q9 <br /> DIN^ EMAIL _ <br /> Cly— / p^J f� —A66>i€S' �— CITY <br /> CONTR.LICENSE p O�^--�� '1' <br /> HEAT SOURCE CONTRACT PRICE OF WORK <br /> USE OF BUIL,D`IN,G,, _ �/ <br /> V`' `-•C 'eEleclr., 0111L <br /> _ I <br /> WORK DESCRIPTION <br /> C)042C % n S Vhal <br /> 40t.o e d [e nq 10M, a DrGq"'e <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO, TYPE OF FIXTURE OR ITEM <br /> 21- Toilet ___ A/C-air handling units <br /> )(_ Bathtub -_ Forced air systems <br /> _25 Lavatory(wash basin) __ Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher ___ Gas range <br /> Clothes washer __ Clothes dryer <br /> _ Water heater Range hood <br /> _ Sink(servicelbadmop/etc.) Exhaust fan <br /> Backflow prevenler Heal pump <br /> _ Urinal Unit healer <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinates governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> /l-l8-200 <br /> Signalure of OwNC itraclor/Authonzrd Agent Date t! <br /> Z <br />