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� z - g-�� <br /> F �RMIT AP�LICATIvN <br /> CITY OF �VERETT PERMlT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-3810- FAX 425-257-8857-tiwrw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CRE�IT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# nPERMIT# <br /> .z7b 7 C��/�i. r S'... F .L a �� - n�z; c ; <br /> LEGAL LOT N . BLOCK TRACT <br /> �ESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �lLS'�"' _�. <br /> r , <br /> ��:f�,'�/�'F.3/ ��,�,�.� ��c� c�/d�,,A�.s{� �;J� �� i,J� ��zo� <br /> , <br /> TENANTNAME CONTACT FOR PERMiT� PHONE <br /> ->i:T s�� l.�b/'��C.!'GCU��iS C.,t�4t'��'T� A�4.ri �1:jtii1�-.�v,(� ?.�-S'Zs2-� S/Ck� <br /> CONTRACTOR AD�RE55 CITY2IP PHONE <br /> CONTR,LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /' �Electric Gas Other �3� ��'� <br /> C_ d7t�/IfPI^G.rti'7� — — <br /> WORK DESCRIPTION_ ,,/Q��(c/l� 5 •w+7-l�s � r 5n+u-ll a,�L� ,4r.��, �Ci�.�.:/�r� S�'^e 2,�;�/«f,a,�� <br /> � .v�cc� Uir..��f�-47(/�✓<�wy�"Y. (1 <br /> � �. <br /> PLUMBING MECHANICAL <br /> N6. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AfC–air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> + Urinal Unit heater <br /> �rinking Fountain Boiler <br /> =1oor drain Re(rigeration <br /> i Grnase trap Woodstove <br /> � Roof drains Oiher <br /> � _ Other <br /> i — <br /> I CIN OF°VERETf�OCAL SALES TAX CO�E IS 7105 <br /> I hereby cerilify that I have read and �xamined this appli;,ation and know the same to be true and corzect. All provisions of laws and <br /> ordinaces governing this rype of worrt will be complied with whether specified herein or noL The granting of a permit does not preswne <br /> to give authoriry;o violale or cancel the provision of any other state cr local�aw regulating consiruction or:h2 performance of <br /> construction.That I am authorized by the owner of this property ro perform the work for which apGlication is made and I comply with the <br /> State Contractors Law 18.27 RCN and 296.200 WAC. <br /> Signature o(OwnerlContractouAuthonzetl Agent Date <br /> \� <br />