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� � <br /> PE,IMIT APPLIGATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> � 425-257-8810- FAX 425-257-8857-www.everettwa.org QjU� <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - JFBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.p RMIT# <br /> �_ �C���'�. �t� �`C��/�1��- C�(7G'ti7�/� ' �v I 15��� <br /> DESC. �OT�. BLOCK TRAC�T� �/� _ �/^ _ ��, <br /> � �� <br /> OWNER pODRES3 CITY2IP fHONE <br /> �/y / -7 /Tj- ��.Sc� '/Z� <br /> L-�L'� ��t��Z(!lt�U�/���� �/-��� � ._� ����L�� �jYI��TV 9 �� <br /> TENANTNAME CONTACTFOR PERMIT PNONE <br /> � %��f� %�l�C1����� ���)- ZSv�' . /Z/Z <br /> CONTRACTOR �,-, � r .,�Z�','Z ADDR7ESS _ ' �,� qTY21P PHONE <br /> CONTR.LICENSE p l/` J/ � . " ���� L�t'7Z� ZSR' /G IZ <br /> USE OF BUIL�0 ING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,�,,�ia (�i'�' �'�'1' /=2�� �;" ,h('",' C[���-!� <br /> Efectdc �Ges Other <br /> WORK UESCRIP710N � - I <br /> , . ) ,Urf;/.j <br /> �i'.e-ct, ��t�i,i'/, ��,.� � �/r;���,t'/ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIR�URE OR ITEM <br /> ,� Toilet �''- A/C-alr handling uNts <br /> � Balhtub �v Porcodairsystems <br /> j 11_ Lavatory(wash basin) � Gas piping �! <br /> Shower / t-' Water heater <br /> i Kitchen sink 8 disposal Gas Oreplace <br /> ! Dishwashar <br /> � Clothes washer � - Gas range <br /> f / �` Clolhes dryer <br /> _ Laundry tray /�� Range hood <br /> -+_ Sink(service/badmop/etc.) -:- Exhaust fan <br /> -c- Backllow prevonter t�d- Heat pump <br /> � Urinal � Unit healer <br /> -�- Dnnking Fountain � Boiler <br /> r Floor drain <br /> — -f= F::Igerallon <br /> _ Grease trap � Woadstove <br /> _, Roof drairs Other <br /> I Olher — <br /> CITY OF EVERETT LOCAL SALES TA7f CODE IS�103 <br /> I hereby ceritify that I ha��e read and examinod this appllcalion and know the same to be true and correct. All provislons of laws and <br /> ordinaces governing lhis type of wo�k will be complied with whether specified herein or not. The granling of a permil does not presume <br /> to give authorily lo violate or cancel the provision of any olher state�r local law regulaling conslructlon or the perfortnance of <br /> construction. That I am authonz �he-�y+'ner of lhis property to porform lhe work tor which application la made and I comply with the <br /> Slale Conlraclors Law a ,�86.200 WAC. 7 <br /> �-� '" .5 /�� <_?S <br /> Signaturo of Owner/ ontractoriAuthonzod Agent ate � I I <br /> � <br /> �/�{,�G(vZB� <br />