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PE:r�MIT APPLICATIG�� <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 /> APPLICATfONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT Ff CREDIT CARDS ARE NOT ACCEPI'�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � 9 �1le.rc(�9.N � �'� y�� - /( <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS ��ITY2IP PHONE <br /> � �� ��c� ;� ��-.�..�- <br /> TENANTNAME CONTACTPORPERMIT PHONE <br /> �"�'�'�`l�`� �\E� �� ��� � A1�� CAS�'��►�)��� �b � ssb - (4�03 <br /> CONTRACTOR I,C�I OJ� �� I �Cller� ADORE CITY/ZIP PHONE 0 � <br /> c�.o3o �2X+� Rv� 't.f � a 4I �sv- ►9a 3 <br /> CONTR.LICENSE# ��\�n � , ' ^ ��� S.�'�'�`.� �J (� ���J� <br /> 1l � ••t <br /> USE OF BUILDING — HEAT SOURCE I �ONTFtACT PRICE OF WORK <br /> a �� <br /> Electric /\Gas_Other ��� �` <br /> WORK �ESCRIPTION �`(�SS ONe. �� 'uQ <br /> PLUMBING MECHANICAL <br /> NJ. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink& disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> I = Drinking Fountain = Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> I = Roof drains = Other�'1 qSS �. <br /> Olher <br /> � <br /> i <br /> i CITY OF EVERETT LOCAL SALES SAX CODE IS 3�05 <br /> iI hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with�vhether specified herein or not.The granting of a permit does not presume <br /> I to give authoriry to violate or cancel the provision of any other state or local law regulating constniction or the pertormance of <br /> ' cons . attmtf'i�l am authoris b the o�vner of this property to perrorm the work for which application is made and I comply with the <br /> St e Contrac�o� 7 RCW an 96200 WAC. � . ( — �� <br /> � l� <br /> , Signac f Owner/ConlractodAutho zed Agent Date �/ <br /> I �� <br />