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PcRMIT 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 6 AM TO 4 PM <br /> SITE ADDRESS` ,I, PARCEL TAX I.D.# PERMIT# <br /> LEGAL LOT NO. BLOCKTRACT OR SUBDIVISION# <br /> DESC. -�G (,fl "N <br /> ' O'53 <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Deo ,4 va' b la On `7 7 016 9 Is+ Ne �E (3Lb)45L/ -5137 <br /> TENANT NAME CONTACT F///O---R��� PERMIT PHONE (J�o)ySy -5137 <br /> �'\' N I JQ h I ( {` r Jot los E•MAILQ e VMIAW199 <br /> CONTRACTOR I <br /> Comet CO/'1SjK)(�jD^ Pnd >< Bbiq _ <br /> CONTR�CENSE# OkL SYl II(, VJP (3b0)4S I 's <br /> CAGLECCgya-NZ �Y <br /> vU�SEE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> t.ua 01 I Electric _Gas_Other IS b O 0 <br /> WORK DESCRIPTION / 7 <br /> �lJ OG Z <br /> ygvj '(,�vA-N ahs 77 <br /> z2x / 9x .y _ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet / A/C—airhandlingunits <br /> Bathtub 11 Forced air systems <br /> 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 _Q Range hood <br /> _ Sink(service/bar/mop/etc.) l0 Exhaust fan <br /> _ Backflow preventer Heal pump <br /> _ Urinal Unit heater <br /> Drinking Fountain Boller <br /> _ Floor drain ;Zk_ Refrigeration <br /> _ Grease imp _ Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 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 /> 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 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 /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> SignalureolOwn racfbr ultwtlzadAgent D to I <br /> /z <br />