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P�2MIT AP�LICATIG�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 TAl(I.D.A P RMIT# � <br /> 35 a � - /32o,� �cc/aY moy3 � 3 g57o27 �0 .� _ <br /> LEGA LO7N0. BLOCK TRACT . <br /> oesc. 2 7 P 2 g � S 7 - /�.�� ll'�1�/2?.�-i�->+ € . <br /> GWNER ADDRESS CITY2IP PHONE <br /> 'j`o n,t - S I�l u �-t 3'D .2 3- C'�'dh.ay�ewt� .�'. �-erult.� PtJ a. 2 52 - `-�'F o <br /> ITENANTNAME I CONTACTFOR PERMIT PHONE <br /> CONTR,qC OR � ADDRESS CITY(LIP PHONE <br /> 5n c� ,eG s �c, i� 5 c �.u . �{j -'- �\'' �� .3(;aC�' / �' <br /> CONTR.LICENSE# �� � � j2L c�_S , � � .r1 -� �/� /�-� `�'��� ���� <br /> `T !� <br /> �S <br /> USE OF BUILDING HEAT SOURCE ONTRACT P ORK <br /> ��t,CLL� �t, 6�-Q' �— Electric _Gas_Other nJj � '�� <br /> WORK DESCRIPTION „pe � -G4.oc- �J�.�,y� <br /> �v�s.re� Q .,ll�»La..(t.' /1G-1zY,,�� r�-c�e. �G � <br /> :l�n; �'t4vd d� y�2 �'✓L� , .icb•Gc�1r.� 8 S �1 �-wx��. <br /> U <br /> PLUMBING MECHANICAL <br /> I NO. IYPE OF FIXTURE OR I7EM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> i _ 8athlub _ Forcedairsystems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Ges range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray F.arge hood <br /> _ Sink(service/bar/mop/etc.) Exhausl fan <br /> _ Backflow preventer Heat pump <br /> Urinai Unit heater <br /> I Dnnking Fountain Boiler <br /> i _ Floor drairi Refrigeration <br /> _ Grease hap � Woodstove <br /> _ Roof drains Other <br /> Other <br /> i <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I he�eby ceritify that I have read and examined this appbcation and know tho same to be true and correcL All provisions of laws and <br /> orC:n2�es governing lhis rype of work will be complied with whether specified herein or nol The grenling of a pe�mit does not presume <br /> to grv�authonly to violate or cancel the provision of any other state or local law regulaling construction or the performance of <br /> construction.That I am authorized by lhe owner o(lhi� property to perform the work for which application is made and I com�ly with the I <br /> State Contractors Law 18.27 RCW and 296100 WAC. <br /> Signature of OwncdContraclor/Authonzed Agent Date i/ <br /> - -- � J <br /> r <br />