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P��2MIT APpLICATlO�� <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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS �r /� PARCEL TAIC I.D.N PERMIT K <br /> r�i/.� CaS�i�p Gr'%T � � <br /> LEGAI LOTNO. BLOCK ThACT � p�-�P „�� <br /> DESC. v <br /> OWN�E�Rl��Q/ ADDRESS CIT'�ZIP PMONE <br /> S J <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � ,��AO S. L F��-�P l�-ti'�.�56- Si�7 <br /> coNranr,roR lJ,� f� /J ,�nr�,'� aooaess,�0,5�/7 /✓ar ��n%E>crcr2ia PHONCi/.ZS�`/8J—�3'ce <br /> � Sno�n.i/� ��iV� �y��' <br /> CONTR.LICENSEN ��pO?�, �. O�T�1 /•� a.�ec/�� �,��AY�//� ���h� <br /> �7 .tX <br /> USE OF dui:01NG HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> ��� 1�;� _Electric Lc Gas_Other I T�m <br /> WORK DESCRIPTION <br /> PLUMBING � MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> � Toilet A/C—alr handling unils <br /> Bathtub _ Forcedairsystems <br /> Z Lavatory(wash basin) Gas plping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas firepiace <br /> Dishwasher Gas renge <br /> _ Clothes washer Ciothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) Exhausl tan <br /> Backflow preventer Heal pump <br /> Unnal UNt heater <br /> Drinking Fountain Boiler <br /> � Floor drain Refrigeratlon <br /> Grease trap Woodslove <br /> Roof drains Othar <br /> Olher <br /> i — — — i — <br /> I _ CITY OF EVERETT LOCAL$ALES TA%CODE IS 7105 <br /> � I hereby ceritify that I have read and ezamined this application and know the same to be true and correct. All provislons of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not. The grenting ot a permif does not presume <br /> to give authonty to violate or cancel the provision ot any other stale or local law re9ulating construcUon or the peRortnance af <br /> construction. That I am autho�rzed 6y the wner of lhis property to perform the work for which 2pplicallon is made and I comply with the <br /> State Co�tors�aw 8.27 GW 6.200 WAC. <br /> %�_ <br /> ' ��;� -� '^^ /�--i/—� <br /> 51§nature of wnen ontrac onAuthon ed Agent —�ate <br />