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PCRfViIT APPLICATIC,N <br /> CITY �DF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—w�vw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBlT& CREDIT CARDS ARE NOT ACCEPTED <br /> S�I]TE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> L�`J SZ� �'P!' �Q �1.� �( ��? � " ? <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AOURESS CITY2IP PH E <br /> �e e� ��-�.�>��C�S (0�1�p� �,�� �.�P_ ��it�t 1�.��3 i--�" In�;��i�3 <br /> TENANT NAME CONTACT FOR PERMIT �PHONE <br /> �.�-�l �,�lC'S2�� 1�i?Lz�, I <br /> CONTRACTOR \�1 1 ADDRESS(�/rnj ,�.t CITY2IP PHONE _ <br /> J '� �Il�1b�.J����ll�'� � ,i . ' '�VC� t�� 4-�aQ�.�ll.�� _ , 1 <br /> C_l_ <br /> CONTR.LICENSE# 1 �G ��1C� ��' ���' I�'���.i <br /> ��� � �jT� Q11�.T�� � �_ � <br /> USE OF BUILDING — HEAT SOURCE ,I CONTRACT PRICE OF WORK <br /> `f'i -� �- /�--� <br /> Electric Gas Other ��L���_]� • �/ <br /> WORK DESCRIP770N �_ ' � <br /> r _ i . � � � /i_. ,, / ! '� ' `J �r,; i <br /> � ._ .. �'!�� ' /��i� ,J. �./�_. 'oi:J �i <br /> i / <br /> ' . . /ii�.;�/(. .'r�/i'� - ,• �-_.. <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR�TEM � <br /> _ Toiiet A/C—air handling units <br /> _ Bathtub Forcedairsystems <br /> � Lavatory(wash basin) Gas piping <br /> _ Shower L Water heater <br /> Kitchen sink&dispo�al Gas fireplace <br /> � _ Dishwasher Gas range <br /> ,_ Ciothes washer Clothes dryer <br /> Laundry Vay Range hood <br /> � Sink(service/badmop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump i <br /> _ Urinal Unit heater <br /> Drinking Fountain Boiler <br /> I _ Floordrain Refrigeration <br /> I _ Grease trap _ Woodstove i <br /> � � _ Roof drains _ Other I <br /> i __ Other .% � .. .,, ,, rr ._ <br /> —�, <br /> _ I <br /> ' CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> ' I hereby ceritify that I have read and examined this applicadon and know the same ro be true and correc:. All provisior.s of laws and i <br /> i ordinaces goveming this tyFe of work will be complied with whether specified herein or not.The granting oi a permit does not presume <br /> to give autho�ty to viol te or cancel the provision of any other stale or local law regulatlng construction or tne pertormance of <br /> construction.That I authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contr 't aw 18. and 290.200 WAC. I <br /> �.e � 7/ ' <br /> Signamre of OwnenConUactor/Authonzed Agent Oate i <br />