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F �RMIT APPLICAT'i�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 /> � -9�as <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TA7C I.D.# PBRMIT_# <br /> � d ,/ � `�✓J ._� L r <br /> / J L V <br /> LEGA LOTNO BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CI7Y21P PHONE <br /> �� .�✓i.�inr�� ,��.�; /c�r� /s/ti CD/_///✓{, �tftr��fl 9��01 yis=1�z -7v�s_ <br /> TENANT AME CONTA T FOR PERMIT PNONE <br /> �vN Pi���l�� /�s "33�- (.�,�o S <br /> CONTRACTOR �p � ADDRESS CIN21P PHONE <br /> �'��IN� �����f iuy i Lr�.r��✓�,�� 9�x-� yh- 3�y-G�4� <br /> CONTR.LICENSE#�pvl�f�,� 9�Q d U/ <br /> USE OF BUILDING I — HEAT SOURCE I CON7RAC7 PRICE OF WORK <br /> � <br /> � , [lectric Gas Other /5 G�J ��� <br /> i �PS/ :�. �C,�'- '. <br /> WORK DESCRIPiION � `,C�4, � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> B�Ihtub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Laundry lray _ Range hood <br /> Sink(service/bar/moplelc.) Ezhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unil healer <br /> DrinY.ing Foun�ain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof dreins Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby ceritify lhat I have read and examined this applicaUon and know the same lo be true and correcL All provisions ot laws and <br /> ordinaces goveming this type ot work will be complied with whelher specified herein or nol.The granting of a permil does not presume <br /> lo give authority lo violate or cancel the provision ot any olher state or local law regulating consWction or lhe peAormance ot <br /> construction.That I am aulhorized by the owner of lhis property lo peAorm the worM,for which application is made and I comply wilh the <br /> S � ontractors �w 7 RWJ nd 296200 WAC. <br /> �/,� � <br /> ���� �/�� �/> /� G�-�i7 � ��" �� <br /> �Sign—atTi�e of Uwn / ntraclor/ uthonzed Agent Date <br />