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PEr�MIT 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.# PERMIT# <br /> /�4 •r �-� � -. Z— <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �i.� S 9� � 1'S..�nh. �a�—�' <br /> TENANT NAM CONTACT FOR PERMIT PHOIYE <br /> CONTRACTOR�g Sp� r0^S � `—� �DRESS �yZ, �Z� <RITY2IP PHONE —�o�,yl2_ <br /> e1 pPp1,g,`.ce�Z.,L. � 1_ JC V <br /> CONTR.LICENSE# ��`^�"� W 2 4���Z y b?y <br /> GIQb�Os �4�uP�5 <br /> USE OF BUILDING HEAT SOURCE � CO TRACT PRICE OF WORK <br /> _Electric _Gas_Other ��j'D� <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> _ Bathtub Forcedairsystems <br /> Lavatory(wash basin) —� Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range , <br /> Clothes washer Cbthes dryer '� <br /> Laundry tray Range hood �� <br /> Sink(service/badmop/etc.) Exhaust fan ��. <br /> Backflow preventer . _ Heat pump ' <br /> � Unnal Unic heater � <br /> � Drinking Fountain Boiler <br /> �� Floor drair � _ Refrigeretion '��. <br /> ��� Grease trap Woodstove �. <br /> I Roof drains � Other GP+�r�c✓ ' <br /> Other <br /> i <br /> �' CITY OF EVERETT LOCAL SAi.ES TAX CODE IS 3105 '�, <br /> ' I hereby ceritity that I have read and examined this apolication and know the same to be true and correct. All provisions of laws and <br /> ' ordinaces goveming this type of work will be complied with whether specfied herein or not.The granting of a permit does not presume <br /> '� to give authonty to violate or cancel the provision of any other state cr local law regulating construction or the perfortnance of . <br /> construction.That I am authoiized by the owner of this property to perform the work for which application is made and I comply wi�;�the <br /> �`\ate C tract1oJr's�Lzw 18.27 RCW a�d 296.200 WAC. <br /> �'. `� \ �/ 1iY` '� �/Z"S/O� , <br /> ; Sign e of OwnedContractor/Authonzed Agent '� . <br /> , i <br />