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; <br /> , , PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> ' 425-257-Bfi10- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT# <br /> � <br /> � : '+.> �� /� r� vu �/ i/ 3C� G O / ,'o�l �` OUr <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITVIZIP PHONC <br /> '' v�s <br /> `� .,� „ �� tiA„�. <br /> TENANT NAME CONTACT O/R PERMIT PHONE <br /> Cvtrj.•�t�t �P�. 9rin�enl �J�,�+-t /�yr'/ � ?G(', 763 / 7%Y <br /> CONTRACTOR � ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE M �vE/�G � � Z o � D 7 <br /> USE OF BUILDING HEAT SOURCE CONTNACT PRICE OF WORK <br /> _Electric _Gas_Olher �I �� 'J ?�j <br /> WORK DESCRIPTION <br /> yl/�c ��� �'/Ks <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—eir handling unils <br /> 8alhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink 8 disposal Gas freplace <br /> Dishwasher Gasrangc <br /> Clothes washer Clothes dryer <br /> Laundry lrey Rango hood <br /> Sink(servicelbar/mop/elc.) t Exhaust fan <br /> Backflowpreventer _ Healpump <br /> Urinal Unit hcaler <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodstove <br /> Rooi drains _ Olher <br /> _ Other _ <br /> CITY OF EVERETT LOCAL SALES 7A%CODE IS 3105 <br /> I herehy ceriti/y that I have read and examined Ihis applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give aulhority lo vio�ate or cancel the provision of any olher stale or local law regulaling construction or the pedormance of <br /> consiruclion.That I am aulhorized by the o�wq er of lhis property to pedorm the work for which applicalion is made and I compty with Ihe <br /> State Contr s Law 18.27 CW and�296:200 WAC. <br /> � �/�"� 3//�s <br /> SignaTure of Owner/C�ct r!A ed Agent Dzte <br />