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PERMIT 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 cj & -a5 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ?O () <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 7C7C3' e,t Acv O 6 <br /> LEGAL LOT NO. BLOCK I TRACT <br /> DESC. JI <br /> OWNER I ADDRESS CITY/ZIP PHONE <br /> u <br /> cyLDIA W1(S1 (o 1.4y <br /> TENANT NAME / CONTACT FOR PERMIT PHONE <br /> S411ct(1004s\i CtA,U / `eve, Ston 2.a(4,-7- -87 E• <br /> CONTRACTOR ADDRE' S CITY/ZIP PHONE <br /> 1v1 t• AA cd-ireht4.Wt LGv�Q0. �-> A tr 7. f Ip I w� <br /> CONTR.LICENSE# '61"--u'l <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> f\dwti niS ra.ki L 0 i c Electric Gas Other <br /> WORK DESCRIPTION <br /> 5 s -� 4vk) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> l Toilet NC-air handling units <br /> Bathtub Forced air systems <br /> 2 gA Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> I Kitchen sink&disposal Gas fireplace <br /> I Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray ._ 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 /> I — <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 ,.rovisions 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 /> 4401 construction.That I am authorized by the owner of this property to perform the woiK for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> - ' q-2Cc,-cS <br /> Signature of Owner/C.itra tor/%uthorized Agent Date <br />