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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-82•10—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � '��/z�/ <br /> SITE ADDRESS PARCEL TAX I.D.ll PERMIT 8 <br /> � . •� 8'L, 5 ���� ��� <br /> LEGA OT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADURESS CITYIZIP PHONE <br /> Oo C� � <br /> TENANT NAME �. CONTACT FOR�RMIT � PHONE T_��3_o oq L <br /> � O�G.ic [� 1 ��(M�p ' GIY E-MAIL� .l � - � <br /> �r' ��^S /9/06 Flw� � aF/4 L��w.,.d 9803� <br /> CONTR.LICENSE M <br /> SP�vs� 9�3-T� — <br /> USE OF BUILDI G I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other � 3000 �= <br /> � — — _ <br /> WOR!(DESCRIPTION <br /> �,„�,�� � �, ►��e�y <br /> �S+G �f S � -�� l✓ti I( <br /> PLUME3ING MECHANICRL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel A/C–air handling units <br /> Ba�hiub Forced air systems <br /> Lavatory�;wash basin) _ Gas piping <br /> Shower Water heater <br /> Y,ilchen sink &disposal _ Gas fireplace <br /> Dishwasher Gas ranga <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urin21 Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT�OCAL 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 corred. Atl provisions of iaws and <br /> ordinances goveming this type of work will be complied with whether specified herein oi not. The granting of a pertnit dces not presume <br /> to give aulhorily to vidate or cancel the provision of any other state or local law reyulat�ng construction or the perfortnance of <br /> conslruclion.That I am authorized by ihe owner of this property lo periorm the work for H�hich application is made and I comply with lhe <br /> Slale ContradorsLaw 18.2 ' nd'�96. WAC. <br /> �� �� �_ �-Z�/� <br /> Signalure�o OwnedContractor/AuthorizeAAgenl Date � <br /> �Z <br />