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P��RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRECT, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCFPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> � 5�6 �'��� , �E �0�/y2 �' -DaYoi9o � poy�z��( <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE53 CITY2IP PHONE <br /> LJa//��,,�-t� Srv,�°Es i� C' zooisr �a r1s� c��.,� �'�s- �»��a <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � ��,��//.��,�� �•�� e�Gs� �zs �-� � z <br /> CONTRACTON ���O�.fGB/ /9,�qytnorA�DRES3 CITY2IP PNONE <br /> yzS -30.3-�7Z <br /> coNrn.��fo�19/.aGG`F f , 8zai <br /> � 'j'7� S�c,�s/ yvE c�:t�E'f< <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> L Electric _Ga�_Other <br /> WORK DESCRIPTION �C�D n �/� � s, � SrtG <br /> L�/ /� V 1 <br /> ���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—aIr handling units <br /> Bathtub Forced air systems <br /> Lavatorv{wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sinK&disposal Gas flreplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mopletc.) Exhaust fan <br /> Backflow preventer � Heat pump <br /> Urinal Unit heater <br /> Drinking Founta�n Boiler <br /> Floor drain Refrige2tion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby r.eritify 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 rype of work wili be complied with whether specifled herein or not.The granting of a pertnit does not presume <br /> Ito give authoriry to violate or cancel the provision of any other state or locat law regulating consWcdon or the performance of <br /> construclion.That I am autliorized by the owner of this properry to perform the work for which application is made and I comply with the <br /> State Contractors Law 1827 RCW and 296 0 WAC. <br /> C�' a � —�---__,�z"z z -� �I <br /> � - a-`� _ <br /> Signature of O r ContractorlAuthorized Agent ate <br />