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F cRMIT APPLICATIvN <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 ��� S�/ PARCEL TAX I.D.# �O�O�'� <br /> �� �IO7 .QrPa' <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER �� `^ ADDRESS CITY2IP PHONE <br /> r V�/', <br /> /7�'/'�tv `z ��' <br /> TENANT NAME CONTACT FOR PERMR PHONE <br /> ��r.-� /L/yv,�' ) r'cg' . �63 - / ?5�5i <br /> ,.� z g� <br /> CONTRACTOR t�����n ��� �»(o ADDRESS � Z 7 e..{!t qTY21P�,��rX/�HONE p� 76 f - <br /> �+ Z ,i.r�, •�c��IY on S�. �� y <br /> CONTR.LICENSE# f✓��QG/ � U r� y/ <br /> 2 //�/ <br /> USE OF BUIIDING HEAT SOURCE CONTRACT PRICE OF WQRK <br /> Electric Gas Other <br /> WORK DESCR�IPTION � � <br /> fr�f+ I-r�C S�/ro( �A�%w�rS�rJ Vnif o..� c%. �/ <br /> PLUMBING MECHANICAL <br /> NO. NVE OF FIXTURE OR ITEM NO. TYPE OF FDITURE OR ITEM <br /> Toile! NC-air handlirg units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping '� <br /> Shower Water heater <br /> _ Kitchen sink&disposal _ Gas fireplace � <br /> Dishwasher Gas range '�. <br /> Clothes washer Clothes dryer '. <br /> Laundry trey Range hood .. <br /> Sink(service/badmop/etc J Exhaust fan �, <br /> Backflow preventer Heat pump ' <br /> Urinal Unit heatef , <br /> Drinking Fountain Boiler �� <br /> Floor drain Refrigeration '. <br /> Grease trap Woodstove - <br /> Roof drains � Otber ��� <br /> Other <br /> CITY OF EVERETT LOClLL SALES 7AX CODE IS 3105 ', <br /> I hareby ceritity that I have read and examined this application and know the same to be true and wrtect. All provisions of laws and ��� <br /> ordinaces goveming this type of work will be complied with whether specified herein or noL The granEing of a permit does not presume �, <br /> ro give aulhonty to viol�te or cancel t vis�on of any other state or local law regulating constructioo or the performance of �, <br /> construction.That I am a�uthor' y the owne pro rty to perform the worfc for which applica6on is made and I comply wilfi lhe ,, <br /> StateContractorsyaW-18.� . � . . �I <br /> ��'C - '^ ! // � <br /> ' ature of OvonedContra on - Date <br />