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PLr�MIT APPLICATICS�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, Wq g8201 <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 N <br /> ti`io� ��vu-iz .4�� IVIO o -03 <br /> LEGA LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE /�5) <br /> l <br /> .�x-�r.� �utt` -�I�o,� �u�u�2 F��e c��xi��ii �F��3 �s� -v�/v7 <br /> TENANT NAME I CONTACT FOR PERMIT PMONE <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> CONTR.LICENSE I! <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> �Lc=cT7ziC 7'U �7/{-j <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 /> 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/barlmop/etc.) E�chaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trep Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS J105 <br /> I hereby ceritify that I have read and examined this applicaUon and know the same to be true and cortect. All provisfons of laws and <br /> ordinaces governing �his rype of work will be complied wilh whether specified herein or not.The grandng of a permit does not presume <br /> ro give authoriry to viola:e or;;ancel the provision of any other state or local law regulating construction or the pertormance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> S 1 Co ctc s Law 8.27 RCW and 296.200 WAC. <br /> / �/ <br /> �-- ' /J�r �9 <br /> Signature'o OW,hedContrecrodAuthonzed Agent Date <br /> / � � <br />