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Pr�RMIT APPLICATILN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM / D � � a —�7 <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT N <br /> — G �,.Q �o�rG• �� I <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDMSION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �// <br /> TENANTNAM CONTACTFORPERMIT PHONE 3((,-�8i2 f/3�� <br /> I�eO/1Gr/G{� ! /GY/'I.Z�� E�MAILroi¢.I/u�TS.� �•��../C <br /> !�G/e mu u�i �'//� � �� 3Cc -�dr7-y� <br /> � ^�'j /0�3rJ/oc��I��/�y, �'R7��"ihv� 95r.?P,2 <br /> CONTR.LICENSEN Fo��.M �h o�?6�lJ / <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���C� _Electric �Gas_Olher ���GQ� 0G <br /> � <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> ,� Toilet A/C-air handling units <br /> Balhtub Forced air syslems <br /> � Lavalory(wash basin) _ Gas piping <br /> Show�r Water healer <br /> � Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> / Water healer Range hood <br /> � Sink(service/bar/mop/etc.) Exhaust fan <br /> BackFlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Fluor drain Re/rigeratlon <br /> Grease trap Woodstove <br /> Roofdrai� 6�66 — °`he` <br /> � Other OJ�' � _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this,pplication and know ihe same lo be true and correct. All provisions oi laws and <br /> ordinaces governing this type of work will be complied with whelher specified herein or not.The granling of a pertnil does not presume <br /> to give aulhoriry to violate or cancel the provision of any other state or Iocai law regulating constructlon or the performance of <br /> conslruction. That I am authorized by the o�vner of this property lo pertortn lhe work for which application is made and I comply wilh the <br /> Slate Con cty�Law 18.27 RCW and 296.200 WAC. <br /> ���/ /o�02-�7 <br /> Si aWre of Owner/Con ctodAuthorized Agent Dale <br />