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P�r�MIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA y8201 <br /> 42.5-257-8810— FAX 425-257-8857 —www.everettwa.org � �a �j`O� <br /> APPLICATIONS ARE ACCFPTED FROM 8 AM TO 4 Pfd - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> c�.� U ��of: ��,� r.� ��.d� q � m ��- >> � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CI7Y21P PHONE <br /> !'�7 �� � �!7 /�/-e /UJ .b tYGr � a.-.� 4 � /�ZJ�/ ��ZS JS S3 -�/yr° <br /> TENANT NAME CONTACT FOR PERMI —�E� <br /> � �z,^-f" C.�r�ron.,�o I �r,�o.���e ��ZS— �1.��S37 G <br /> CONTRACTOR � �'l ,�l ADURESS CITY2IP PHONE <br /> �-i S'}Yti �'-7` <br /> CONTR.LICENSE# <br /> USE OF BUILUING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric �Gas Other <br /> WORK DESCRIPTION ��u l�s��� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C-airhandlingunits <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> Laundry tray � Range hood <br /> Sink (service/bar/mop/elc.) Exhaust fan <br /> I _ Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> ; Drinking Fountain Boiler <br /> i _ Floor drain Refngeretion <br /> i _ Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I <br /> ' I hereby ceriti(y that I have read and examined lhis applicafion and know ihe same to be true and correct. All provisions of laws and <br /> � ordinaces governm ,1his type of work will he complied with whether specified herein or�ot.The granting of a permit does not presume <br /> � to give authonty wolate �ancel tf�provis'on of any other state or toca�law regulatt�g construction or ihe performance of <br />- constructiqn. at I am onzed y th ery f this prope e�the work for�vhich application is made and I comply with the <br /> i State Co[atr ctors 7 RC �6 WA <br /> /i <br /> i�"/ <br /> � Si �tOr enContr or/Authorized Agent �ate �/Z <br /> i I <br /> i _ _ . <br />