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PEKMIT APPLICATIO�v <br /> CITY OF EVERETT PERMIT SERVICES �_ a�-oy <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org �L �/�j�_COc� <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 F <br /> �� � �V¢.�- vo..-. � G✓Ge.�lv/*Q 20 ��___� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS CITY2IP PHONE <br /> S, bl� i/7�� ��� ,�uer e..... G.�.. ��r�l{�cl�Lo'/ �/lS 3S3 -`/z/yv <br /> TENANT NAME CONTACT FOR PERMI —�ONE� <br /> .��z,�� C�ro.�.�6 I � �io ti� ��l,�.�o ��25- �/.��f-S37 G <br /> CONTRALTOR � � � I . ��� ADDRESS CITY2IP PHONE <br /> ��S p�+-r <br /> CONTR. LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT�RICE OF WORK <br /> _Eledric �Gas_Other <br /> WORKDESCRIPTION _�c�¢_i�y_��t <br /> ��:���s���as�<_: �,•__-_ <br /> � <br /> PLUM8ING MECHANICAL <br /> NO. I 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 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray � Range hood � <br /> I _ Sink(service/har/mop/etc.) _ Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> = Roof drains I = Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3 i05 <br /> � I here6y ceritify that I have read and examined this applicaUon and know the same to be true and correct. All provisirns of laws and <br /> ordinaces govemin his type of work will be complied with whether specified herein or not. The granting of a permi:does•not presume <br /> to give authonty violate ancel t provis'on of any other siate or loc2 law regulating construction or the performance of <br /> construction. at I am orized th er f this prope orm the work for which applicatlon is made and I comply with the <br /> State Co ctors RC 6 WA <br /> i <br /> Si r v enContr orrAuthonzed Agent Dace i/ <br /> Z <br />