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PEMIT 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 /> rr APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS 58 O4' c/L Y RD . PARCEL TAX I.D.# PERMIT# <br /> EVER 7Y, 9893 00z/4/3/ ODQ 4/C'0 / 3 7® ! <br /> , c=2/ <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER SAAR / S ADDRESS CITY/ZIP PHONE <br /> sV e—r L A- NA 5804 cA Z y 8,D 4 YER E- 7 T 58dv0 3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 442'5.." 6/3 - 5-4/35 <br /> 5 <br /> CONTRACTOR )>1',4-/ 6 I L/$ ADDRESS CITY/ZIP PHONE <br /> s Y TL.4"".. 5804/ cA-2>Y iW. EvLR ELY �9 g b3 <br /> CONTR.LICENSE# I <br /> USE OF BUILDING ita51 <br /> HEAT SOURCE CONTRACT PRICE OF WORK <br /> yvviL 11.-�.5t+erot� Gas_Other <br /> WORK DESCRIPTION <br /> � � <br /> 13' $i 14tRieb gb )71 o id <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 /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer 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 Contractors Law 18.27 RCW and 296.200 WAC. <br /> p/Sigp Vt—l® 01,0-0/7— <br /> Signature <br /> nature of Owner/Contractor/Authorized Agent Date <br />