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P��RMIT APPLICATI(�N <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 3�->>1 C PARCEL TAX I.D.8 PERMIT p � <br /> •�- � ouJww �VJL � ���� 'W� <br /> LEGA LOTNO. OCK TRACT <br /> DESC. <br /> OWNE�R pDORESS CITY2IP PHONE <br /> —\ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��z.��5 I '��1� 1.,��,c�, ���L 36a- 42�(- �32s— <br /> �ONTRACTOR ADDRESS � CITY2IP PHONE <br /> �lt�(�J'S+�.n� ����.f{�5� 26v8 tt�w.( 9q So� V1/�W•.�T �(Mo�t 36��y?�[' �3�3' <br /> CONTR.LICEN N ��,� <br /> USE OF BUILDING �u� I — HEAT SOURCE I CONTRACT P<R�OF WORK <br /> S�^�`�'-�'<<N s Electric Gas Other ,�� �l7 <br /> WORK DESCRIPTION <br /> i�s�-�� a. w�,_,U( S� ��5 <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling units <br /> __ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Clothes washer C�othes dryer <br /> _ Laundry trey Range hood <br /> Sink(servic</barlmop/etc.) Exhaust fan <br /> _ Backflow preventer Heatpump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> _ Floordrain Refrigeration <br /> _ Grease trep Woodstove <br /> Roof drains Olher <br /> Other — — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br /> � hereby cerilify that I have read and examined this application and know the ssme to be true and correct. All provisions of laws and <br /> iordinaces governing this 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 violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> consWctlon. That I am authorized by ihe owner of this property to perform the work for which application is made and I comply wilh the <br /> Slate Cuntractors Law 18.27 RCW and 296.200 WAC. I 2-I� 'U� <br /> � ��`�-i/�i <br /> ISignature of Owner/Co ractoqAuthonzed Agent Date �/ <br /> � <br />