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P�r2MIT APPLICATIG�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857 –www.everettwa.org 3 �3 �5 <br /> APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM - DE81T& CREDIT CARDS ARE NOT ACCEPTED <br /> S17E ADDRESS PARCEL T�qAX I.�.A PERMIT it /� /� <br /> � ' .. . �/ ✓ `jLJ� '%V.Y. C7�J�GUG '- �(J/ �V!/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. _ ``• � ; _� � , <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��87�0/ <br /> f�>, �; ,-,. � , ,- . ,, �r u ! ; i �l Co�Gv t=ve�'e7T��4 yzS- ZS�-S9�-f <br /> TENANT NAME I CONTACT FOR PERM T PHONE <br /> CONTRACTOR (j !.,) r�' ,":� L �( AODRE55 CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUIL�ING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,����� '`� ������ � �� • SrQ `�Electric _Gas_Other ����� <br /> r — <br /> WORK DESCRIPTION <br /> � . �. ,-�'. . , _, I�Pf�I-71o�.1 <br /> ;:� 1_� �'- i;..��- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �.,; Toilet A/C—air handling units <br /> Bathtub ForceA air systems <br /> Lavatory(wash basin) Gas piping <br /> ` Shower Waterheater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry Vay Range hood <br /> Sink (service/badmopletc.) _L Exhaust fan <br /> Backflow preventer Heatpump <br /> Unnal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drein Refrigeration <br /> Grease trap \Noodstove <br /> Roof drains Other <br /> Other <br /> CIiY OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> I hereby ceritify that I have read and examined this application and know th=same to be true and correct. All provisions o(laws and <br /> ordinaces goveming this type of work wtll be complied with whether specifietl herein or noL The granting of a permit does nol presume <br /> to give authonty ro violale or cancel the provision of any other stale or bcal law regulating consWction or the performance of <br /> construction. That I am aulh i2ed by the owner o(this pmperty to perform the work for which application is made and I comply with the <br /> Slale antrectors Law 18.2 CW and 296200 WAG ' <br /> f ' �' _� <br /> /};'j i i /—� ;: -.,.,, <br /> Signature of Ow qCon ractoriAuthonzed A ent Da;e �I L <br />