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�— <br /> PrRMIT APPLICATI(�N <br /> i CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA �8201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org f Z,_p 9 -0� <br /> I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS P.RE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PE�iMIT <br /> �i'v2s' ,�� a � y� 2 - D -ov Z - o ao ��� -oc� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESG ,.pd �( � i ef <br /> pyy ADDRESS CITY2IP PHONE �� <br /> /% / )�al fU/ /�`1 /� ti .�/ /�e 0�3��1'J 9�'0/1 b� <G <br /> TENANTNAME C ACT ERMIT PHONE <br /> --- I�/r„J, ., � �i �i'?t'-l�1- ( G <br /> CONTRACTOR /��� ADDRESS CITY2IP PHONE <br /> v <br /> CONTR.LICENSE X <br /> USE OF BUILD G HEAT SOURCE CONTRACT PRIC�E OF WORK <br /> � �r�. � ,�Electric _Gas_Other /J DQ��— <br /> S '� � <br /> WORK DE�IPTION � 1 <br /> ' / /��u.v.uy Flw�r,t l �' �e�ri�i.K� fic7� � �/bp�5 Co✓r%�, 1 <br /> / eo <br /> ��Ct � ^ S vwf 9 �v�y , � ` Q n�-�ti� <br /> �,�/ � � ^ry ' ' ��►^f�O� l �.liS^ '/KI� ��.,�.` � <br /> PLUMBING 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 /> �_ Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> % Kitchen sink&disposai _ Gas fireplace <br /> l Dishwasher Gas range <br /> Clothes washer Ctothes dryer <br /> l.aundry tray � Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Back(Iow preventer Heat pump <br /> Urinal Unit heater <br /> I I _ �nnking Fountain _ Boiler <br /> Floor drain Refri9eration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> _ Other _ i <br /> CITY OF EVERETi LOCAL SALES TAX CODE�S 1105 <br /> I hereby ceritify that I have read and examined this application and know ihe same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be compliea with�vhether specified herein or not.The granting of a permit does not presume <br /> to give authonry to violate or cancel the provision of any other state or local law regulating cons:ruction or the performance of � <br /> consWction.That I am authorized bv the owner of this pmoe .ry to perform the work for�vhich �pplicalion is made and I comply�.vith the <br /> Stat n ctors Law 18.27 C nd 296200 WAC. <br /> ' � 0 <br /> � - <br /> igna ure ot O�vnenC � ractor/Authonze0 Agent Date <br />