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P�RMIT APPLICATidri <br /> CITY OF EVERETT PERMIY SER�'ICES 7 _� �-� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 n�" � /}/_ <br /> 425-257-8810-FAX 425-257-885%-www.evereKwa.org /�(�(/ �ULl� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE PDDRESS PARCEL TAX I.D.i1 PE IT N <br /> I i i ► �KE r�vc oc� $ 35 ��5U0 ' <br /> LEG LOT NO. BLOCK TRACT J <br /> OESC. rj .f (p 35 (p t JL-'RL� �� J� 1W�1 !� <br /> OWNER ADDRE33 CITY2IP PHONE <br /> T � 339-Wd� <br /> 1,AN d V PN�SSP �uq I711 1JA�=� AUG. �✓tR{j� �]$;�DI <br /> TENANTNAME � I CONTACTFORPERMIT PHONE __— <br /> (�1 D NE <br /> CONTRACTOR �e r� ADDRESS CITV2IP PHOHE <br /> CONTR.LICENSE N <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Liu � N1 / �es��CQ�t.c _XElectdc �Gas_Other 9�9 <br /> WORK DESCRIP770N <br /> �.�.;+,��, � �,,� - y��d ��,�;� sp�� as#��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> I Tollet A/C—a�rhandlfngunfls <br /> � Bathtub _ Forced alr systems <br /> 1 Lavalory(wash basln) _ Gas plping <br /> Shower Water heater <br /> Kitchen slnk 8 dlsposal _ Gan fireplace <br /> Dishwasher Gas range <br /> Ck,thes washer _ Clolhes dryer <br /> iaundry Vay Range hood <br /> Sink(service@ar/mopletc.) � Exhaust fan <br /> Backliow preventer _ Heal pump I <br /> Urinal Unit heater <br /> Drinking Fountaln _ Boiler <br /> Floor drain Refrigeretlon <br /> Grease lrap _ Wcodstove <br /> Roof drains Other <br /> Olher <br /> CITV OF EVERETf LOCAL SALES 7AJ(CODE IS 7105 <br /> I hereby ceritlfy that I have read and examined lhis application and know lhe same to be true and cortect. All provislons of lews and <br /> ordinaces goveming this type ot work will be complied with whether specifled herein or not.The grenting of a permil doea not presume <br /> to give euthoriry to violate or cancel the provlsion o(eny olher state or local law regula�Jng corstructlon or lhe pertortnance of <br /> construction.That I am aulhoriz by lhe owner of this pmperty to perform the work lor which applicatlon Is made end I comply with the <br /> State Cphtractors Law 1827 R and 296.200 WAC. <br /> � �. 6 iy a <br /> S gn ure o ner ac ze g e�e ��Z <br /> v <br />