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PE��MIT APPLICATIC��� , <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettH�a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT�4CCEPTF6D <br /> ��i�1' h"7 <br /> SITE AODRESS PARCEL TAX I.D.# ERMIT# <br /> O � C� ',✓ �� �1 ZO c� O — <br /> LEGA LOT NO. BLOCK TRACT � <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR (?p��Z��'tlN DL�/J')I�n/(� ADDRESSr2 �IZI �7� Oe SC CITY2IP PHONE <br /> v ,4 ��ir,v,4, 70� 7v 3 - Zz.� <br /> CONTR.LICENSE# Q�g��.Q�q/ / �/`/ �KZO�' <br /> o` � IbC� ( ( <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORKDESCRIPTION , c2 C' LoS e ' �' CFI ✓ f-I ,.�D� c- c- <br /> �L a- T��.v+ ot% (✓/t' ` 4 / gP�� <br /> PLUMBING MECHANlCAL. <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—afr handling units <br /> Bathtub Forced air systems <br /> � Lavatory (wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Ciothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer _ Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Fioor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> �_ Other ._. <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> � hereby ceriti(y ihat I have read and examined this application and know lhe same to be true and correct. All provisions of Iaws and <br /> ordinaces governing this t work will be complied with tvhether specified herein or not.The granting of a pertnit does not presume <br /> to give autho iol cancel the provision of any other state or local law regulaGng construction or the pertormance of <br /> const rt-'fi i orized 'y th�-ywner of this property to perform the work for which appiication is made and I comply with the <br /> ont� ct a 27 RCW and 296.200 WAC. <br /> � - <br /> i atur o er/Contractor/Authonzed Agent Date <br />