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PARMIT APPLICATI041 <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 — www.everettwa.org Pt,) 7- 016 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> /'/ ( StSF �� ° i <br /> / �` OoUu _, Oct � �-r 7 - co <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. 2 3 4.„ /. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> X</ZZ 4' Gz 2L C X76/Ar 9e) Citi 5--z./ c zt 4.5-7_2,-- y <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ifir,4e."'C'1A'-' . <br /> CONTRACTOR /� ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# ,- `er .` ; <br /> 0 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> evele7 _Electric '` Gas Other 25 U a c..., <br /> i WORK DES RIPTIO <br /> � C/_. ) / Ly ‘I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet NC-air handling units <br /> / Bathtub / Forced air systems <br /> Lavatory (wash basin) .l-/ Gas piping <br /> <-1 Shower / Water heater <br /> / _ Kitchen sink& disposal / Gas fireplace <br /> i Dishwasher / Gas range <br /> / Clothes washer Clothes dryer 1 <br /> Laundry tray Range hood <br /> Sink (service/bar/mop/etc.) ,r 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 /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions 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 /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Cont actors Law 18.27 R and 296.200 WAC. <br /> 75-w.f. "7 - 6v-C-- <br /> Signature of Ownet7 ontractor/Authorized Agent Date / <br /> (...,-53 ( �cj `,'l l <br />