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r <br /> '' �; Y y3�kbt� <br /> ----i. r . <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982Q1 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS O'- �j3 PARCEL TAX I.D.# PERMIT# <br /> o �n t �I(�,lZ� `? <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONEZC��O��S`�`'�I �O <br /> ���°.�na� �r,ti oa.n� t�b 37D7 �Fo4 'Sea�(,c.c�. �t�Ll <br /> TENANT NA I C NTACT FOR�P'E-R_MST PHONE�� r'Z�r(,��""��' <br /> �AY1tQ T�ln • <br /> E-MAIL � <br /> CONTRACTOR � TAC ADDRES (�� s �� �f CITY/ZR��CPHOI�{��r� � <br /> rY T� �� <br /> . <br /> CONTR.LICENSE# <br /> 1�(�t.�4�I.3?�I 1Jb <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ' Electric Gas Other � <br /> ,� - - �D,���,.,�..- <br /> WORK DESCRIPTION t -��•� �;„�� p�, �:����:�.�Q✓ C�'?.�,C��4'�• k . <br /> �� ���� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units �Q'�o�-t' <br /> Bathtub - Forced air systems �sc�ark. <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater , <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Ciothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/baNmop/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 lS 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 /> constr tion. That I am authorized by the owner of this property to pertorm the work for which application is made and I compiy with the <br /> State o tra tors Law . 7 RC and 296. 0 WAC. ' <br /> �'. .,� <br /> Signatur r/Con ractor/Authorized Agent Date <br /> '� <br /> -�..�_�. <br />