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�Lr2MIT APPLICATIG��J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9b201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org � `3 �O6 <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM - DEBIT 8 CREDI7 CARDS ARE NOT ACCEPTED <br /> SITE SS I PARCEL TAX I.D.p P RMIT A <br /> •� l�+l� D (o,����1� � Sb7- � <br /> LEGA LQT�10. _ BLOCK TRACT <br /> DESC. G��� f�� <br /> OWNER ADORESS CITY2IP PHONE <br /> �U. C-a'�Ml�r,�'v G�t,1�4+ 2�3 Cd 2 . <br /> TENANT NAME C01{TAmFO�PERN4IT PHO <br /> �� AF� olA1 A1�irZ � P�� A�r�t��cr�-5 <br /> (� �2- �� <br /> CONTRACTOR -�-� S��pNL�2Zt7lQuR SS , CI��� ��1/pN7E <br /> ` // � /� /� C1f/.q <br /> CONT�,R.,L�NS� �� � \ I L L �/ / �P/YrI % OD� / <br /> �T' V �� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ����..{� _Electric _Gas_Other _��(�� � <br /> � � <br /> WORK DESCRIPTION r <br /> �n�l �IGt t�iv/1 0� � rUW ��t/G�1�/�' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYFE OF FIXTURE OR ITEM <br /> Toiiel A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal Gas flreplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servica/bar/mopletc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinat Unit heater <br /> Drinking Fuuntain 8oiler <br /> Floor drain Refrigeralion <br /> Grease irep Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritiy that I have read and ezamined this appliwtion and know the same to 6e true and correct All provisions of taws and <br /> ordinaces governin� Ihis type of work will be complied wilh whelher specified herein or not The granting of a permit does not pmsume <br /> to give aulhonty to violale or cancel lhe provision of any olher state or Iocal law regulaling construction or the performance of <br /> construc .That I am authorized by tho owner of this property to perform the work for which applicatioa is made and I comply with the <br /> Slate C a for w 78 and 296.200 WAC. <br /> i <br /> Signa re o( �vnedConlracrodAuthonzed Agent Dat �/� <br />