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PtRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettvia.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> PARCEL TAX I.D.# PERMIT# �D 0 <br /> SITE ADDRESS ID q O O O 0 <br /> fDE <br /> LO[TI/N BLOC I� TR T / <br /> . / �( <br /> OWNER �1,,��,, AO SS CITY2IP PHONE <br /> B�ac �lur�l Proners� Bo1c433 Sr,�1>am(sh 1PZ91 (425)231-7733 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 1 AA1114n 610'( V'n �425� Z32-F133 <br /> CONTRACTOR �IpO!r rkjrgj/ ,R4jrC ADDRESSC?G/Jr LkOt CITYIZIP PHONE <br /> Lt Sk✓tof <br /> cottrR.LICENSE aREf/ABE>F 973DSY M 9-4— <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas_Other D, L,70 <br /> WORK DESCRIPTION <br /> in v <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 /> _ Lavatory(wash basin) Gas piping <br /> Shower L Water heater <br /> % Kitchen sink d disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer T Clothes dryer <br /> _ Laundry tray Range hood <br /> _ <br /> sink(servicelbar/mop/etc.) Exhaust tan <br /> Backfiow preventer _ Heat pump <br /> —_ Urinal — Unit heater <br /> Drinking Fountain Boller <br /> Floor drain T Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other. <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces 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 stale 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 1 comply with the <br /> State Contractors L w 18.27 RCW and 298.200 WAC. <br /> & W& r 8a s <br /> Sig taro o wner on actor Authorize gent Date I <br /> L <br />