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P�rtMIT APPLICATI��1 <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 RM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS (� PARCEL TAX I.D.# PERMIT tf <br /> �5 �U�OI��(LINY .X�'{ lG-G/� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> � � mut 3� o F1ci�i�ys <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �QRRY $ RISe�vo 3(�o -S� ' `� 0�� <br /> CONTRACTOR �eR��5 P �4 ADDREiS CITY2IP PHONE <br /> ' �g33 � 33 Ro pes�� . q�a�o`�� ��o� 56� -ya�i <br /> CONTR.LICENSEli � � Q ^L Je�Ryi�� �� , /UO S�OhU�V1l�'1� <br /> /7 RJ �( <br /> USE OF BUILDING I � HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION /� R Uu IU � �U� (`� � � "J <br /> l� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling units <br /> BathWb Forced air systems <br /> � Lavatory(wash basin) Gas piaing <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Ciothes washer Clothes drver <br /> Laundry tray Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions ef laws and <br /> ordinaces governing this type of woik �vill be complied with whether specified herein or not.The granling of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> /��ti�%��w C�'o��- ��� <br /> i ure of O er/Contractor/Authonzed Agent Date <br />