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PE���MIT APPLICATIOiv <br /> C17Y OF EVERETT PERMIT SERVICE5 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> ��G'3 ���'��'G�l tiJ}�- � ����' �� � <br /> DESCL �Tf10%� BLOCK /£�,IT ,/(CLS ��' �/L �C� P� . / <br /> r (J V /1 <br /> OWNER � A�DRE55 CITYIZIP PHONE <br /> S�G���x-�1 �cf���c� v�t� �a,���� ���3 �����u �i � 9�3 ZS`�-32�0 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> S%��iuli( f�Wf,C-S • L�(�N� D .CR�IuJrUi�i� .�NC. �2j�3��—�S12Z <br /> CONTRACTOR t ADDRE55 CITY2IP PHONE <br /> ��,R�� o . c2� wra�, ,tir �{ka� �o� �. ,- f����7i, cc�' SFz��3 �zS�3y3 -�iz <br /> CONTR.LICENSE# <br /> D�A,��o�� �� ,<G <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eiectric Gas_Other <br /> WORK DESCRIPTION � <br /> ��a� 33� s� �f Ya ��S�G+� \ S�UY'n� �"/`-�.�r��'L . <br /> ) Cl <br /> PLUMBING MECHANICAL <br /> NC�. TYPE OF FIXTURE OR�TEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air han�ling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink& disposal Gas fireplece <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry t2y Range hood <br /> Sink(service/b2dmop/etcJ Exhaust fan <br /> Backflow preventer Heatpump <br /> Uriral Unit heater <br /> I _ Drinking Fountain _ Boiler <br /> �loor drain Refrige2tion <br /> ' Grease trap Woodstove <br /> i _ �oof drains _ Other _ <br /> , Other <br /> i — <br /> I <br /> � <br /> I CITY OF EVERETT LOCAL SALES SAX CODE IS J105 <br /> II hereby ceritify that I have read and examined this application and know the same to betrue and correct. All provisions of laws and <br /> I 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 authonty to violate or cancel lhe provision of any other state or local law regulating construction or the performance of <br /> constmetiaa`at I am authorized by the owner of this property to perform lhe work for which application is made and I comply with ihe <br /> Sta�e C ntracto w 18.27 RC and 296200 WAC. <br /> i , ���.-� � <br /> ISignat f�Uwner/Contractor/A thonzed Agent Date t/z <br />