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P�.�ZMIT APPLICATI��� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.��g <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDR CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P RMI <br /> � �� �C 3 ��l <br /> L GA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> '�; I L `��3 l� 5�.. "�,9 I 6 2 ��e�Q-� l,�y ���c� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> - (� � ao o — 8" <br /> CONTRACTOR DRESS CITY2IP PHONE <br /> CONTR.LICENSE N � 111 " � �� `��\/ '�^� ��, s� A-lo z ��e�� u>4 q�ao� <br /> L\� V �� <br /> USE OF BUILDING �— HEAT SOURCE CONTRACT PRICE OF WORK <br /> � x Electdc Gas Other <br /> i — — <br /> WORK DESCRIPTION r60'F <br /> �J4- oti q �e� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTi1RE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtub Forced a'-systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwaslier Gas range <br /> Ctothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(service/baNmop/etc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritiy that I have read and examined lhfs application and know the same to be true and correct. All provisions af laws and <br /> ordinaces goveming this lype of work will be complied wilh whether specified herein or not.The granting of a pertnit does not presume <br /> to give authonty lo violate or cancef the provision of any�ther state or local law regulating construction or the performance oi <br /> construction.That I am aulhorized by the owner of lhis pwperry lo pedorm the work for which appl(cation is made and I comply with the <br /> State Contractors Law 18.27 i<CW and 296.200 WAC. <br /> �L/l 3'It�b "c� <br /> "ir. <br /> Signature f OwnedContractor/A t orized Agent —�'ate <br />