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PE�ZMIT ApPLICATIO�d <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-?57-8810— 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 ADDRESy r 1 U�7 PARCEL TAX I.D.# P�g MIT <br /> ( ��U�, �f r u. y� �vl, ( I ;'S ���Co <br /> LEGA LOTNO. U BLOCK TRACT <br /> UESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> / <br /> l�-('I I <br /> TENANT NAME CONTACT FOR PERMIT PHOt�E <br /> ,�c�e�1 h���inkerti-S�.rfl�. ,�a��i� yls-Z��- /� �'lo <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTF..LICEN.;E# <br /> US�:OF BUILDING I — HEAT SOURCE I CONTRACT P�ICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> �-�S�J�..�sso f�t�i�C - " 1Y1���C�C,�CS �x,p2�ss. -� o <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OP FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink ;service/barlmop/etc.) Exhaust fan <br /> Backf�w preventer Heat pump <br /> Urinal Unit heater <br /> � Drinking Fountain Boiler <br /> i _ Floor drain _ Refrigeration <br /> Grease trap Woodstove <br /> ! Roof drains Other <br /> � _ Other__ _ <br /> � <br /> ' CITY OF EVERETT LOCAL SALES 7AX CO�E IS 3105 <br /> iI hereby ceritiPj that I have read and examined this application and know the same to be true and correct. AII provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or r�ot. The granting of a permit does not presume <br /> � to give authonty to violate or cance!the provision of any other state or Iocai law regulating consWctlon or the performance of <br /> � construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> � State Contractors Law 18.27 RCW and 296200 WAC. <br /> I� �/l3�Dy <br /> Signature oi Owner/ContracrorlAuthonzed Agent Date <br /> ��Z <br />