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PERMIT APPLICATION <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 /> SIT ADDRESS PARCEL TAX I.D.N PER/MIT A <br /> /j Sri ,si - DO L/ 717 0 DW 2bQz C- I(Y -ocS <br /> LEGAq LOT NO. BLOCK TRACT OR SUBDIVISION 0 <br /> DESC <br /> OWNER ADDRESS _ CITYIZIP PHONE '7 <br /> �pn� vL/Q!�/�C✓ l//� .S S/te T �r9. a3 l�.l�"/�o-FUQ <br /> TENANT NAME CONTACT FOR PERMIT PHONE -760- -715-f <br /> •G I 5;f zv�-;rf✓ EATIA11 tQC01nC� +e <br /> CONTRACTOR Se/ c P -— <br /> CONTR.LICENSE 0 nla.. <br /> USE OF BUILDING HEAT SOURCE CON R/AC7T PRICE OF WORK <br /> _Electric Gas_Other / <br /> WORK DESCRIPTION T0,,1 1f,C rr)&I17 (Ijea/-6r40ryq k," 7y oam a7 7o,4/4j <br /> L✓kt/ 740 6,-e.?-/C *, r4AM" crud f jec 41) -H7--c 7` Aee 5 ;49 04'07 <br /> i -6-On) -/ , mwsAc- bto)i' 7, To be Core cc.iY, Z`r'r//�3 rddmS <br /> /II >-AefjouSe, /70 Ce fibr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C - air handling units <br /> Bathtub Forced air systems <br /> 2 Lava ory(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 (servicetbar/maptelc) Z Exhaust fan <br /> BackOow preventer Heat pump <br /> Urinal __ Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trip Woodslove <br /> _ Roof drains Other <br /> Other -- ------ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby certify that I have lead and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances 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 ,18 227 RCW and 298 200 WAC. . <br /> Signature ofner/Contreclot/�nzed Agent Date �v <br />