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P`�RMIT APPLICATI(��y <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> .�J`_7L 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> J(fT}� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDReSS PARCEL TAX I.D.# P IT iF <br /> 3 3� r, Z -Z <br /> GA LOT NO. LOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE yZr��_yy '7 <br /> rm c.,,.NN��i�. a3�,� ,�o w�, qtsz�3 <br /> w , rM�.�,v� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> (�u�z►vos sul� PP�-\ ��s�-c�va �Zs- z.�-�9 � <br /> CONTRACTOR ��R�� ��� ��DDRESS CITY2IP PHONE <br /> ��yzc 2Z.�1'�c.n.t y2S-26� -G5 <br /> CONTR.LICENSE 8 f[r�� 9565 3 <br /> �EIZFCGS02Zi�� .� �� ��p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric �Gas_Other I S 5['U � w <br /> WORK DESCRIPTION � �V��„��L <br /> �NS��� (� T"�� �J�NP � RC\C/�C�LL'Q UN �\ <br /> � n.s:n-�� ���h �t�, �4�� 2i �u��t�x�i�G <br /> S�,Si A�1 CLR�iS a. 1�Uvc.� � O V u c.�x�•/� <br /> PLUMBING MECHANICAL <br /> IJO. TYPE OF FIXTURE OR I7EM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toiiet � A/C—air handling units <br /> _ Bathtub Forced air systems . <br /> Lavatory(wash basin) Gas piping � <br /> Shower Water heater <br /> Kitchen sinY,&disposal Gas fireplaca <br /> Dishwasher Gas range <br /> _ Ciothes washer Clothes dryer � <br /> _ Laundry tray Range hood <br /> _ Sink(service/badmop/etc.) ,� Exhaust fan <br /> Backflow preventer Heat pump <br /> , Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refngerati � <br /> , _ Grease trap Woodstove � <br /> j ' Roof drains Other <br /> I Other <br /> I <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and c ect. All provision aws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granti oes not presume <br /> to give authonty to violale or cancel the provision of any other state or local law regulating consWctlon or the performance of <br /> constru tion. 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 /> Stat on ractors L 18.27 RCW and 296.200 WAC. <br /> I 'I „�- � Iz �� <br /> Sig ture of Own n ontracroqAuthonzed Agent ate � I/L <br /> I <br />