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P!RMIT APPLICATIJ <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.# PERMIT# <br /> 5‘).2_ Ciy►„>,irc,a A--,,Y _ -- A I 1 13 -7 2 e 70Y- 003 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE .tZi-,232-307] <br /> ..._` n1-F >L''sfliv 4-ti-A-rki,t,-) /C -/c 2j3 AI k) _ ,/jL L /L76 a,J4 912 -7 N---- <br /> TENANMI NAM CON I AL I rvtt Ytttltdil I PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR. LICENSE# Ow it---(A--) <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> j� s/ Electric Gas Other 3�z <br /> WORK DESCRIPTION _A,,„to ,X tti / Cie►t,.., ,17r ill. /3i---St ISD "ii /a--1-4j-e- L k' <br /> - ller- — .&j /u cn Thtt / ( . ? _ sp4 a I "-All)ha' di .9d/-1 e. r -6)1e. t td <br /> Ont24-1-i3 61-6A .-t 4 -tif S►A� - .At iv c4.ti-..S Shdwr,-tea olC wvi.f- 4i r1 i -Hi . %7-...rrfs:.i diirrt ctiv‘ <br /> n.l- S--te r Ceti-c <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 1 Toilet / A/C-air handling units <br /> Bathtub I Forced air systems <br /> I Lavatory (wash basin) / Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> J 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 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 /> I 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 am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State ntractors Law 7 RCW and 296.200 WAC. <br /> Signature of Owner/Cont ctor/Authorized Agent C Date <br />