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p`RMIT APPLICATII,N <br /> CITY OF EVEZETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS 16�g �('jAf�)C(� PARCEL TAX I.D.A� PERMITtM <br /> _�� ,-r �c�438a 6�a3oo D so6 <br /> _EGA LOTNO. BLOCK iRAC7 � , <br /> �,esc ' �3 d Z 3 6 F'dh'Rh7T l�i✓ N <br /> OWNER ADDRESS CITY2IP PkIONE <br /> C�<ua,��- ���,v�- gia� 6y�"pl2 N!' mu��;�re,wk �j'�5-.26j� i763 <br /> TF:NANT NAME CONTACT FOR PERMIT PMONE <br /> CONTRACTOR �E"yS�(�O �'�°OXx 'e'�DRESS y ��c� _ Z,�,��mmP PHONE <br /> CONTR.LICENSEp ()0b6 pj� 7Slay /3 ��yS�'z S�lolion�rSN ��S" ��`$355' <br /> �f fr�90 <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �ElecMc Gas Other -rj vUU <br /> i <br /> WORK DESCRIPTION <br /> ��mv�r�r�an �—�2.. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTVRE OR ITEM <br /> � Toilet A/C—airhandlingunits <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) Gas piring <br /> `�hower Water heater <br /> � Ki�chen sink&disposat _ Gas fireplace <br /> Disli�vasher s range <br /> � Clothes washer ,� CI es dryer <br /> Laundry�ray Rang ood <br /> Sink(service/badmop/etc.) Exhaust <br /> Backtlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountaln Boiler <br /> Floor drain � Reirigeralion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritiy that I have read and examined th(s applicadon and know the same to be We and wrrect, All provfsfons of laws and <br /> ordinaces goveming lhis type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authoriry to viotate or cancel the provisfon of any other state or local law ngulaling constructlon or the perfortnance of <br /> construction.That I am autho ' d by the owner of this property to perform lhe work for which application is made and I comply with the <br /> State n�aclors Law 18.27 and�.96_200 WAC. <br /> "lit� i L?'i• � `ll� <br /> i nature of Own /ContractodA onzed Agent Date <br />