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Dec-08- 10 09: 22A -. ., ._ 1, . 01 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 88201 <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. a PERMIT# <br /> Z / - Kdr/T PI s <br /> " L LOT NO. BLOCK TRACT OH SUBDIVISION N <br /> VFW —� <br /> owwHER . h--/. �L ._ A DRESSCI�Ip PNpf1E '-- <br /> // Ch <br /> TENANT NAME CONTACT FOR PERMIT _ PHONE <br /> 2;1CONTRA�TOIR <br /> -- _ E-MAILADDRESS _ <br /> 1TYThA <br /> y!� <br /> CON R.LICENSE 0 rt 5- e5Y-ZAG S <br /> USE OF BUILDING HEAT SOURCE v I CONTRACT PRICE OF WORK V <br /> Elnrtdq r Gas_„ Other y 7 Z <br /> WORK DESCRIPTION - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO, TYPE OF FIXTURE OR ITEM <br /> Tuitut AIC-air handling units <br /> I Bathtub <br /> Forced air systems <br /> LAvatery(wash hasin) Gas piping <br /> Shower water heater <br /> Kilchou sink&dislxrsal Gua fireplace <br /> DishwasherClo ,-, Vas range <br /> Wdlhes heeler <br /> _ Clothes dryer <br /> Sink l healer Rongc hood <br /> Sink Ilow p ivenImolllolr..) _ Exhaust fan <br /> Backllow prevenlnr _ Heal pump <br /> Urinal Unit heater <br /> Drinking Founteln Beller <br /> Floor drain Refrigeration <br /> _ Groase trap Woodstovo <br /> Hoof drain. Other <br /> Uthor ` <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I Il,tehy cotitify that I have read and examined this application and know the Same 10 be We and correct. All provisions of laws end <br /> on inaeos governing this lyoe of work will bn complied with whmhor specified herein or not.The granUng of It permit does not presume <br /> to,live authority to vf0hate of cancel the provision of any other state or local how regulating cunstrucllun or Ihn pndormance of <br /> con.twction phot I am nuthort7od by the owner of ihls property to pe,ferm fife work for which application le mndo And I Comply with the <br /> Stain rbntr Wrii Law J.H.27 RCN' and 200.200 WAC. <br /> Sienaluiu u t worn :nniruaorlAuf lunznd Agent Date �� <br />