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Amft <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> -- — <br /> Cola 1 A.rrs, *,, - j ! ("� <br /> L.EG LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER / ADDRESS CITY/ZIP PHONE <br /> tJ ��oJW G-aslL(0.1,d (Na.,,d Cry ) vto.v�d C�) �' -olev. coo•. <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 6yWeks) Gftf -7 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> k fr`s 7 t L% Ar,tu^ /S dJJ 7 2-SC o <br /> CONTR.LICENSE# <br /> NoR tfcjtf 2-75 JF <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> w J-e-�6 v,y P-/b C _Electric _Gas_Other 2- �� �� C-0 <br /> INORK DESCRIPTION �� <br /> t us� Pa l I e� R a GO 1 Sf <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 Water heater <br /> Ktchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <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 /> 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 /> 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 r authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Cont ctors 18.27 RCW and 296.200 WAC. <br /> Signatur wner/Con for/Authorized Agent Date <br /> LC� <br />