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. n. � 'l���� � <br /> �� <br /> PERMIT APPLICATION <br /> CITY O�F 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 � �L�.O ?j �? PARCEL TAX I.D.# PERMIT# <br /> O �n 1 �--6�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONEZ�(�.�a..(„� 30 <br /> (��Ir1 C� M�l�.�1 u rCJ �7��� �Fl9A ���� �b�Z� <br /> TENANT NA I C NTACT FOR PERM T PHONE�(o .`L�"�.(,Qs'3�e <br /> `` � _ � N <br /> Ar1t iZ T'1���t n <br /> E-MAIL <br /> C NTRACTOR � '�1�^` ADDRES `� +� �� A1 ITY/ZI��PHOf�{€�l� �'�► <br /> �Y r/ �'1. <br /> CONTR.LICENSE# <br /> t��t.��t3�q ab <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> • Electric _Gas_Other ` �� ���� <br /> WORK DESCRIPTION ' <br /> �1�1��.Ct.� aSSo�;�c�*� �u.c�wor<<. � <br /> Q�, ru-�k.c�.► (����ocw�.s oa�,�..c�i-o�n.�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units �az4oGt• <br /> Bathtub Forced air systems �a.c.e-e."�-cc�Ck• <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Ctothes 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 certify that I have read and examined this application and know the same to be true and correct. Ali 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 perform the work for which application is made and I comply with the <br /> State o tra tors Law . 7 RC and 296. 0 WAC. <br /> b"� <br /> Signatur r/Con ractor/Authorized Agent Date <br /> . '� <br />