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P`�RMIT APPLICATIt�N <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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ��IrC' �ve�i reEv� �t,�'c�� 11A 0 12-G3$ <br /> LEGA LOTNO. BLO TRACT � <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> .L��tiIS �'0 Pz✓'�-, � S <br /> TE ANT AMEn I CONTACT FOR PERMIT PHONE <br /> �-� /�;�ro 1c-�'� l���s yz5 - 34�_ :;5�`� <br /> CONTRACTOR D��E � v��s' AOORESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE I . CONTRACT PRICE OF WORK <br /> Electric X Gas Other <br /> WORK DESCRIPTION 2 V�� � �r����� J \ E I <br /> � ' <br /> � �C�cS 1 �-�^ct5 �•,✓�tQc�' <br /> �-0 doyh �h�-� u�,der• U� 16s. � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTIIRE OR ITEM <br /> _ Toilet A/C—airhandlingunits <br /> _ Bathtub � Forcedairsystems <br /> _ Lavatory(wash basin) X Gas pipirtg <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(service/badmop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal � Unit heater <br /> D7nking Fountain Boirer <br /> � _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> ICITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <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 whether specified herein or not. The granting of a permit does not presume <br /> ito give authonty to violate or cancel fhe provision of any olher state or local law regulating construction or lhe performance of <br /> construction. m authorized by the owner of this property to perform lhe work for which application is made and I comply with the <br /> e Co ors w 18.27 RCW and 296.200 WAC. <br /> ! � � �� Iz-zi - c� , <br /> IS' nat �of Owner/Coniractor/Authorized Agent Date <br />