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� PLr�MIT APPLICATIL�� j <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ! 2 �� <br /> 425-257-8810 – FAX 425-257-8857 –www.everettwa.org Z � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS _ I PARCEL TAX I.D. # PERMIT# <br /> � � � ���'1 n� I1 � c��.� -00� <br /> If_ ll 7 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE �� <br /> a' �u,�ao, ���a�� 2�3 cua�� rx �.�-�! c�U ���aa.3 63 <br /> �TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR AD�RE55 CITY2IP PHONE <br /> CONTR.LICENSE# J( �r 1 ,�/✓ <br /> /� ��J I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other � <br /> WORK DESCRIPTION , <br /> Ii — (l�✓ <br /> GCJOC'�'� � t�i/� �? .� <br /> I PLUM8ING MECHANICAL I <br /> I N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE QR ITEM — <br /> Toilet _ A/C—air handling unils I <br /> Balhtut Forced air systems <br /> Lavatory(wash basin) _ Gas piping I <br /> Shower _ Waterhealer <br /> i _ Kilchen sink 8 disposal Gas fireplace <br /> _ Dishwasher _ Gas range I <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> � Sink (service/badmopletc.) _ Exhaust fan <br /> Backilow preventer Heal pump <br /> � Urinal � Unit heater , <br /> ' Dnnking Founlain Boiler i <br /> jFloor drain Refrigeretion <br /> Greasetrap � Woodstove <br /> Roof drains Olher <br /> Olher <br /> i <br /> CITY Of EVERETT LOCAL SALES TAX CODE IS 7105 I <br /> I hereby ceritity that I have read and exammed this application and know the same to be true and correct. All provisions of laws and i <br /> orAinaces governing this type of work�.vill he complied with whether specifietl herein or not. The grentin� of a permit does not presume � <br /> to 9rve authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of ! <br /> construction. That I am authonzed by the owner of this property to perform the work foi which application is made and I comply wilh the <br /> State Contracmrs Law 18.27 RCVJ antl 296.200 WAC. <br /> % ., <br /> � � ,r.7�0 S ��o'� " <br /> g ature of wner;ContractonAuthonzed Agent Da�� <br />