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� PE.ZMIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <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&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PF,�2MIT�i <br /> il� ` dqr� Ave E�ary- wk9P,w <br /> (, b�� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> � �.�cIS<'� � Mat�hew Q�each 2Z�, qd� wtS Av� �vcvc{t 9fyzu3 y�5 z9o5/Z3 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> (� �v��{Sty or Mctilhrw �euc t� NZ5 290 5�23 <br /> CONTRACTOR ADDRES CITY2�P PHONE <br /> � J� <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> j�n �e 1,�1�� ` w o S;c�CM� _Electric _Gas_Other <br /> WORK DESCRIPTION ACI � aI A S Ye � �y C�, <br /> �l <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OP FIXTURE OR ITEM I <br /> � <br /> Toilet _ A/C—air handling units i <br /> Bathtub Forced air systems <br /> Lavatory�wash basin) � Gas piping I <br /> Shower Water heater <br /> Kitchen sink&disposal _� Gas fire�lace <br /> Dishwasher Gasra�ge <br /> Clothes washer Clothes dryer <br /> I = Laundry tray � Range hood <br /> Sink(service/bar/mop/etc.) 6chaust fan <br /> �� Backflow preventer . Heat pump <br /> �. Unnal Unit heater <br /> ', Dnnking Fountain _ Boiler <br /> � Floor drain � Refrigeration <br /> � _ Grease trap _ �W„e stove <br /> ��. Roof drains . <br /> I Other <br /> . CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I 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 rype of work will be comptied with whether specified herein or not.The granting of a pertnit does not presume <br /> ' to give authonty to violate or cancel the provision of any oMer state or local law regulating construcUon or the parformance of <br /> �� construction.That I am authorized by the owner of this property to perform the work for which applicatlon is made and I comply with the <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> ,; � �z� z��y I <br /> �� ign r of Own ontractodAuthonzed Agent Date I <br /> � I <br />