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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 - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D. # PFRMIT# <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. l� c�7 -ub O `1 c <br /> OWNER ADDRESS CITY/ZIP HONE <br /> ;:)13�,I - Ll-C , 61,5x- <br /> TENANT <br /> 13a TENANT NAME CONTACT FOR PERMIT PHONE y„_ <br /> �_1�, ��•��1. 1 <br /> EMAIL • <br /> n .laxe, L_ v��..`aN..ra..nl�-1-C 1"j1.��a- _�r� —A:,,—. •�—l'_ �C�IIPb- -,1ICaFTRA <br /> -its <br /> CONTR. <br /> CONTR.LICENSE# <br /> A 1,A-xR (zLo3zL-I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Sxn Qi cL <br /> `�� " �_I ���} _Electric ✓Gas_Other 14J r 00 D <br /> WORK DESCRIPTION <br /> c� 1�.r n,,s f��,u� I gay <br /> S�k,vot-Q- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet AIC-air handling units <br /> $ Bathtub Forced air systems <br /> 9 Lavatory(wash basin) Gas piping <br /> _ Shower _L Water healer <br /> Kitchen sink&disposal I Gas fireplace <br /> Dishwasher I Gas range <br /> Clothes washer _L Clothes dryer <br /> Water healer I Range hood/ I11%V< <br /> _j_ Sink(servicotbarlmop/etc.) _ Exhaust fan <br /> _ Backflow prevenler Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boller <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodslove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceritify 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 ewmpliod 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 /> Slate Contractors Law 18.27 RCW and 298.200 WAC. <br /> •tea `i 31A 09 <br /> Signature�IOwnerlContra lorlAulhonzed Agent Dato <br /> Z <br />