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� P�RMIT APPLICATI�N � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVFRETT, WA 98201 <br /> 425-257-8810 — 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 ADDRESS PARCEL TAX I.D.# PERMIT if <br /> �SS.S� (.c��S' � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> I <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> //7T/I� �fl�""�/!2 S /77J/f� I /5(-/Ll cJ'rG!) ( �.s� �—J'/� <br /> CONTRACTJR � AODRE55 CITY2IP PHONE <br /> E���� �rr� N�r� �4/� ?�z� �i�'� F� 9flzo/ <5�J zsz 3ii� I <br /> CONTR.LICENSE#� i <br /> ���sar�aT— <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK � <br /> f..��� ��� _ElecMc Ges Other �?, 8�7� � <br /> WORKDESCRIPTION Ftt�tSl{ f �S'�ac-i—(�) ST'a+—� IZTK lJ� ou+p o- ��4c� Sj/ST��t <br /> I ��fs l:��-, Cc-�rnoZ 4ai•w�� �uc� w� GwGy o,� Ex�snr�e 3ra,� �Tu. <br /> I <br /> I PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I = Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> I _ Lavatory(wash basin) � Gas piping � <br /> ' Shower Water heater � <br /> �I _ Kitchen sink 8 disposal _ Gas fireplace � <br /> Dishwasher Gasrange i <br /> � _ Ciothes washer _ Clothes dryer <br /> � _ Laundry tray Range hood <br /> _ Sink(servicelbadmop/etc.) � Exhaust fan <br /> i, Backtlow preventer Heat pump <br /> Urinal Unit healer , <br /> _ Drinking Fountain � Boiler I <br /> _ Floor drain Refngeratlon <br /> _ Grease Vap Woodstove i <br /> I , _ Roof drains _ Other <br /> _ Olher _ I <br /> � —I — I <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis applicaticn and know the same to be true and correct. All provisions of laws and � <br /> ordinaces goveming this rype of work will be complied with whether specified herein or not The grandng of a permit does not presume � <br /> to give authonry ro violate or cancel the provision of any other state or local law regulaung construction or the perfortnance of <br /> constn:ction.That I am authorized by the o�vner of this property to perform the work for which application is made and I compty with the � <br /> State C U ors Law� C and 296.200 WAC. <br /> i <br /> �� � 7�2���5� J' I <br /> Sign�re of 0��ractor'Authonzed Agent te ��o� I <br />