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r r <br /> PEr2MIT APPLICATIG�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX �125-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P,g RMIT# <br /> � c wN �►Q,�v�3 .._ 3 0o r�410 `or5'' <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> 987A3 �}z5 <br /> -�o s t+ Sl�w loso cl�ou�N �� (�c�eiT Wk zsz - l 3�{ �- <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> -�pw N�--�s ,.i�� il.loo,��: a�o c��1 5q�19 <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> �M co�sr��cnon, NW T.�c 8cootn 13ST'`ER..7.�w �AiCYu�u-�= �(�o coSZ zs�(0 <br /> CONTR.LICENSE il � W�� <br /> ��� C,O/J� c�f�--M� �—��i'- O� <br /> USE OF BUILDING HEAT SOURCE OONTRACT PRICE OF WORK <br /> �-�� �� ,�Electric _Gas_Other ,1� � U� O O J <br /> WORK DESCRIPTION � <br /> —�(_.'11�0 �� �� �►�—SC-����lU I� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—afr handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer, <br /> Laundry tray Range hood <br /> Sink(service/bar/mopletc.) Exhaust fan <br /> Backtlow preventer Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> iCITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and corcect. All provisions of iaws and <br /> � ordinaces governing !his type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> , ro give authoriry to violate or cancel the provision of any olher state or local law regulating constructlon 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 /> Slate C tractors Law �8.27 CW znd 296.200 WAC. <br /> �_ <br /> nature of wnedContrac or/Authonzed Agen Date I/y <br /> I � <br />