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P�RMIT APE'��CATIC►N <br /> CIl"Y OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, 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 RMIT# <br /> L L' � 1-� - l.0 l� " ` - -O� a- p• . <br /> LEGA LOTNO.^ BLOCK TRACT <br /> DESC. �„ L <br /> OWNER ADORESS CITYfZIP PHONE 3r�c � <br /> � rn��Cl l,i� �((1(lf ��I U ') � ��� �-���y a O��i <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> � <br /> CONTRACTOR AD�RESS CITY2IP PHONE <br /> CONTR.LICENSE# /'',� `���,\ <br /> V <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electnc Gas Other <br /> WORK DESCRIPTION <br /> �V� - _ S = 11 -- 1�) ' - VY I <br /> PLU BING CHANIC /�� <br /> NU. TYPE OF FIXTURE OR ITEM N� NO. IYPE OF PIXTURE OR ITEM V <br /> _ Toilet _ A/C—air handling units <br /> _ Balhtub Forced air systems <br /> _ Lavatory(tivash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> i — I — <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 7105 <br /> , I hereby ceritify that I have read and examired this application and know the same to be true and correcL All provisione of laws and <br /> ordinaces governing this rype of work�vill be complied wilh whether specified herein or not.The granting oi a permit dors not presume <br /> to give authonty to vialate or cancel the provision of any other state or local law re9ulating 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 wmply with the <br /> Slate Contractors La�v 1827 RCW and 290.200 WAC. <br /> ' �C`'1"�lC'i �'l��C�YZ��� ���0 ��.C� <br /> ! Signature of Owner/Contractor/Authonzed Agent Date <br />