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P�.�2MIT APPLICATIG�J <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.# �ERMIT# <br /> /O/Z • I�YOLiG�i./�- �k``�= Evc'✓ Z D - DO 2 .� VI - 3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �'ae I-{ , UI-� /o yo . �roc,�(�a� F�r�evo'� t,czs ) 3 uu-oGo � <br /> TENANTNAME I CONTACTFOR RMIT PHONE <br /> CONTRACTOR AD�RESS CITY2IP PHONE <br /> CONTR.LICENSE# � �/ �1 {� �� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� � � ✓ Electnc _Gas_Other <br /> WORK DESCRIPTION <br /> (7C�1ri p � i�1 ���'� <br /> PLUMBING MECHANICAL <br /> NO, TYPE OF FIXTURE OR ITEM NO. TYPE OP FIXTURE OR ITEM <br /> Toi�et A/C—air handling units <br /> .� Baihtub Forced air systems <br /> Lavatory(wash basin) _` Gas piping <br /> ,�, Shower .� Waterheater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes�vasher Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Unnal � Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease irap Woodstove <br /> Roof drains Other <br /> Other <br /> i CITY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br /> � I hereby centify that I have read and examined this application and know lhe same to be true and correct All provisions of laws and <br /> , ordinaces governing this rype of work will be complied with whether specified herein or not.The granting of a permil does not presume <br /> ' to give authonty to violate or cancel the provision of any olher state or local law regulating wnstructlon or the performance of <br /> construction.That I am aulhorized by the owner ot this property lo per(orm the�vork for which application is made and I comply with the <br /> State Contractors Law 18.2/7 RCW and 296.200 WAC. <br /> /� � ..1-�• / -��� ,/27/� � <br /> Signature of wnedContraclor/Auihonzed Agent �Date <br />