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F AMIT APPLICATI,- N <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 /> SITE ADDRESS PAR L X I.D.p PERMIT p <br /> 30 S 611N STS£ S `�j 1r0000oat ov " ODs- 4Q <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION A <br /> DESC. <br /> OWNER {. ADDRESS CITY/ZIP PHQ)• ajy <br /> 0061 n 0mi4ih (I till saw�e o5 c/bau.e 4�//�SS <br /> TENANT NAME CONTACT FOR PERMIT �P"2�3--332 'y 7Lz5 <br /> �1(/'V 6a1l / E-MAIL <br /> CONTRACTORQ CA'7 eV <br /> CONTR.LICENSE M l/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> JInb,u _Electric XGas_Olher <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> a Toilet A/C—air handling units <br /> Bathtub Forced air syslem•i <br /> Lavatory(wash basin)r-otindi S k k Gas piping <br /> Shower Water heater <br /> T Kitchen sink 8 disposal I Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer I Clothes dryer <br /> Water heater Range hood <br /> (� Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heal pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boller <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 certify that I have read 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 properly to perform the work for which application is made and I comply with the <br /> Slate Contractqrs LrM 18.27 RCW and 298.200 WAC. <br /> S. (O <br /> nature w r/ ontractor/ uftrized Agent Dale <br /> 2 <br />