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I' <br /> PER <br /> MIT AF� <br /> PLICATION <br /> _ CITY OF EVERETT PEi2MIT SERVICES <br /> 3200 CEGAR STREET, EVERETT, WA 90201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 6 CREDIT CARDS ARE NQT ACCEPTED <br /> SITE ADDRESS I PARCEL TAX I.D.# PERMIT# <br /> ;7 Z (o r wG �rY. 7C�� v � '�_ <br /> LEGAL LOTNO. BLOCK TRACT <br /> CESC. <br /> OWNER'`ly � �`1��I / �1_ ADURE55 CITYIZIP PHONE <br /> U 1�1 1('„ C-0 T� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �7ct�mU � S�e �Ee�var�" 5(cU-7qy-�(�21 <br /> CONTRACTORN1p�hE I-�EA�T4.'F,'LR,� ADDRE;S'1 .T7PS{. SE ^nulL�e PHONE �!"Ir � <br /> Q IV (, 3r�o - ���r 8�: I <br /> CONTR.LICENSEM 1^(J�rC���;�� �� � 0�- � —U(J 'LVZ7Z <br /> USE OF BUILDING HEAT SOUR E I CONTRACT PRICE OF WORK <br /> (� �'�j(,� _Electric _Gas_Other ��� 5� <br /> WORK DF.SCRIPTION I�, <br /> _ �t�vl(;1✓l� i�l^�jr��11i'v��- o�- � �ISI �`�!� `��i✓����'� S�'S�C'6'✓I <br /> Y <br /> PLUNIBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel AIC—air handling units <br /> �athtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas firepiace <br /> Dishwasher Gas range <br /> Clmhes washer Clc'hes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backllow prevenler u Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boilcr <br /> Floor drain Refrigeration <br /> _ Grease lrap Woodstove <br /> _ Roofdrains l �� Otl�er S r I tF�� �S <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type ot work will be complied with whelher specified herein or not.The grantiny of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any olher state or local law regulating wnstruction or the pertormance of <br /> construction.That I am authorized by the owner of this property to perform the work for which applicatior is made and I comply with the <br /> Stat Contraclors Law 10.27 RCW and 296.200 WAC. <br /> - ,.,,� � � <br /> Sign ure of Owner Contractor/Authorized Agent e <br />