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PE.tMIT APPLICATIC�,d <br /> CITY OF EVERETT PERMIT SERVICES , <br /> 3200 CEDAR 5TREET, EVERETT, WA 98201 <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.# P MIT# <br /> 5 - ° � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PXONE <br /> �nr� / ' /�c �"'��� FV `T!7(/J ��J-1���H CVG CI 1 �� L72' � 7V <br /> /�/IA/OI /�1 l <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> N � �r1� <br /> CONTRACTOR �(��7y �(��I��.C..� �DRESS �Q� �[� x CITY2IP PHONE <br /> CONTR.LICENSE# �� ��E�� 4L5 -355-g3 <br /> O�pA-1 ( t7 ��F�-6� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> s �� _Eieclric _Gas_Other " q 31L.� � <br /> WORKDESCRIP710N ��F 5�_�AKES TELI.TZ ��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FD(TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—alr handling unils <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(servicelbarlmop/etc.) _ Exhaust fan <br /> Backflow 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 /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the sarne to be true and correct. All provisions of iaws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or Iocai law regulating construction or the performance 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 /> State CQ tractors Law 18.27 RCW and 296.200 WAC. <br /> �� �� �, <br /> Signature of OwnedContracror/Authonzed Agent Date <br />