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P�r2NlIT APPLICATIG�d <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � PARCEL TAX I.D.# P RMIT# <br /> �-��3C� C����, � �r� � �3 - �� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PNONE <br /> r��'lrr•� �'�r/C(l�� ���5'U C�L�3y tJv�s �1l-f Uc ����- <br /> TENANT NAME CONTACT FOR PERMIT PHONE -C� <br /> ✓t7{^v7`P I �/'�`�^—� ���l.��.J O c��� <br /> CONTRACTOR /l(''4��1(5'AN '� fCuu%2. qDDRESS�pf'/ �p�J�l� j�(�C.'CITYRIP PHONE � <br /> CONI'R.LICENSE#����(/PG C��S�(1- � �� / v�� �Of � �/� <br /> �Z JL <br /> USE OF BUILI7ING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> fj��,�;� S �" _Electric _Gas_Olher I (���/OD� <br /> WORK DESCRIPTION <br /> ��(i11��'/� /i1�J�L .5�,✓G� � :1,��� ��S <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. IYPE OF FIXTURE OR ITEM <br /> _ Toilel A/C—air handling unils <br /> � Bathtub _ Forced air systems <br /> ,Z Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> _ Kitchen sink&disposal Gas flrepiace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Cbthes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/badmop/etc.) Exhausl fan <br /> _ Backflow prevenler H�at pump <br /> Urinai Unil heater <br /> Drinking Fountain Boiler <br /> y Floor drain Refngeralion <br /> Grease tra <br /> Roof drains Olhe�rst._�� �i/Fl /O /�'�V � ��=✓�P ' <br /> Other — � <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby cerili(y that I have read and examined this application and know the same to be lrue and correct. All provisions of Iaws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or noi.The granting of a permit does not presume <br /> lo give authonty to violate or cancel the provision of any other stale or local law regulating consWction or the performance of <br /> construction.That I am aythonzed by the owner of this property to pertorm the work for which application is made and I comply wilh the <br /> Slate Centractors i,�w, 8.27 RCW and 296.200 WAC. <br /> � ��l �—US <br /> / .�� <br /> Signature oi�er ContractorlAuthonzed Agent Date <br />