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� _� s -6S <br /> P�RMIT APPLICATIO�� <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 /> APPLfCATIONS ARE ACCEPTED FROM 8 AM TO d PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# <br /> .;`��i��J � �// � � � � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PMONE <br /> �uc��e:� ��r� /�N �7t Y ��.. � Gc/A(( Cve�.Z�� u�rl <br /> u <br /> TENANi NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR �Q U�l�» u.++D���5 ADDRESS Z ��J p �Z41H CITY2IP �iJ�_ PHONE �� � . y�-Ll <br /> .� �L�.lt •coCf (� <br /> (�(��— �1! y � <br /> CONTR.LICENSEqT/DD/`r � � 2� 2-C Z ! b' ZZ� <br /> iL <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION � <br /> r,�c� -� � O�„f <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Balhlub Forced air systems <br /> `-� Lavalory(wash basin) Gas piping <br /> Showe� � Walerheater <br /> Z Kitchen sink&disposal Gas fireplace <br /> Oishwasher Gasrange <br /> Clothes washer Cbthes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Baci:flow preventer Heal pump <br /> Urinai Unil heater <br /> � Drinking Fountain Boiler <br /> Floor drain Reirigeration <br /> Grease trap Woodslove <br /> � Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily lhat I have read and examined lhis applicalion and know the same to be true and corcect. All provisions of laws and <br /> ordinaces goveming Ihfs typo of work will be complied with whelher specified herein or not.The granting of a permil does not presume <br /> to give aulhority to violate or cancel lho provision of any olher stale or local law regulaling conslruction or lhe performance ot <br /> construction.That I am aulhorized by Ihe owner of lhis propeKy to peAorm the work tor which applicalion is made and I comply with lhe <br /> Stat� o Gact s Law 1 . RCW and 296.200 WAC. � <br /> `����.,.� �{- 2�=o-s <br /> 4ignature o 0 er/Contraclor/Aulhonzed Agent Date <br /> � \/1 <br />