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P�r2MlT APPLICATIG�J <br /> CITY OF EVEFtETT 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 /> SI7E ADDRESS PARCEL TAX I.D.# PERMITl� <br /> �/�E� g G'7�t��G,2c�-✓ �� � -O <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWN�R ADORESS CITYIZIP PHQNE <br /> �/Yi� ���`'�c <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> nr,n����� �tr�,�- 'r F�Y✓� ��,✓�-Lc� �zs. ��o � ,P� � a <br /> CONTRACTOR �n��� J'l(v�/ ft�'7QU/�t-T ADDRESS CITY2IP PHONEy2��30,�/F7 <br /> / G 'l/ 7 /Jm�c.'2C -E✓d2F7'l� /}+.��y <br /> "ONTR.LICENSE# -v r�r2 3 j <br /> � ���$"�/S Z' �j C)��� /t7lG t C�LcLrIC i I,Ci/�" �'�b � Z- <br /> USE OF Bl11LDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /l'IUL�(f—j cN'�� Electric Gas Other �" 3 �o ^� �- <br /> WORK DESCRIP710N <br /> o:�e rr�.,/ /JiJP�,/ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM - <br /> � A/C—air handling units <br /> Forced air systems <br /> .vash basin) Gas piping <br /> Sh�.. � Waterneater <br /> Kilchen sink&dis s Gas firepla <br /> _ Dishwasher Gas ran�q _ <br /> Clothes washq Clothe,s drya�� <br /> _ Laundry tra�/ _ Range�hoo <br /> Sink(service/ adm /elc.) Exhaust fa <br /> Backflow pre nt Heat pu <br /> Urinal Unit he er <br /> _ Drinking Fou ain Boiler <br /> = Floor drain Refr' eration <br /> Grease tr p W dstove <br /> Roof dr ins her <br /> _ Other�_ _ <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3�05 <br /> I 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 whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to v'olate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.Th t I m authorized hy the owner of this property to perform the work for which application is made and I comply with the <br /> Slate Contra rs �w 18.27 RCW and 296.200 WAC. <br /> / ! �� `��� <br /> Signature o � edContractodAuthorized Agent Dat ��� <br />