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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 - mvvv.evereltwa.org 1 -8 Z `of. <br /> APPLICATIONS ARE ACCE,TED FROM 6 AM TO 4 PM ��407 2 j <br /> SITE ADDRESS �, p REEL TAX I.D.# P MJT <br /> X17 23 <br /> LEGAL LOT NO. BLOC TTFIACT <br /> DESC. �/� y/ <br /> OWNER ADDRESS CITYIZIP PHON2 W" <br /> TENANT NAME CONTACT FOR PERMITP ONE <br /> CONTRACTOR ADDRESS CITY(ZI Ql, / <br /> ee^744611;1-61- /le Cvfa?rirwA 9dls� <br /> CONTR.LICENSE# <br /> /6—z3-U7 cai9>nN <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> "OL//� )( _Electric Gas_other -- — %J 7/0L <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ToiletQ A/C—air handling units <br /> Bathtub Z Forced air systems✓ <br /> Lavatory(wash basin) ✓ Gas piping <br /> Shower✓ Water healer✓ <br /> 2 Kitchen sink 8 disposal ✓ Gas fireplace <br /> 3 Dishwasher ✓ .L Gas range-0' <br /> Z Clothes washerN Clothes dryer✓ <br /> Z Water healer Range hood ✓ <br /> _fL Sink(service/bar/mop/etc.) Exhaust fan <br /> Backfiow preventer Heat pump <br /> Urinal Unit heater <br /> L Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE 19 5709 <br /> 1 hereby ceri0fy that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinates 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 /> construclion.T a authorized WIhe owner of this property to perform the work for which application Is made and I comply with the <br /> State Conlr ors C nd 296.200 WAC. <br /> Slgnalur Owner! ontractor/ ul orized Agent Date <br /> U�'LcJ lY„8 S <br />