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-ll�o <br /> _ .r — <br /> � � ;,���'��-��;��-j P�..ZIV�IT APPLICATIG�J <br /> -� ��'��� �Y i��" � CITY OF EVERETT PERMIT SERVICES I <br /> ' . � 3200 CEDAR STREET, EVERETT, WA 98201 I <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 ADOR�SS PARCEL TAX I.D. m P RMIT# <br /> /�/ - ��Lr�77�" /�iz �CJS-0 l - OG'{ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER � AD�RESS CINfZIP PHONE � <br /> � <br /> � o.-s��� �� �.(%<�� /3/�. �, ��-�c'S �o.`-z_ I�" ,1- �.i ,,�; <br /> TENANT AME I CONTACTFOR PERMIT PHONE <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> CONTR.LICENSE# ��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRI�E OF WORK <br /> Electric Gas Other <br /> JVORK DESCRIPTION • /_ <br /> �c� ��� � ,'���� `,, lc (�% 7`7��-e-5 I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITE:N <br /> Toilet A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W ater healer <br /> Kitchen sink&disposal Gas fireplace <br /> � Dishwa,her _ Gas range <br /> �! Clothes washer Clothes dryer <br /> �, Laundry tray _ Range hood <br /> ! _ Sink(service/bar/mop/etcJ Exhaust fan <br /> I, Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> i , Fioordrain _ Refr;geration <br /> Greaso Vap Woodstove <br /> � Roof dreins Other_ <br /> Other <br /> I II <br /> � CITY OF EVERETT LOCAL SALES 7AX CODE IS 1Y05 <br /> i <br /> � I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ; ordinaces goveming this type of work will be complied with whether specified herein or not.The granting cf a permit does not presume ' <br /> to give authoriry to violate or cancel the provision of any other state or tocal law regulating construction or the performance of I <br /> � construction.That I am autherized by the owner of this property to perform the work for which application is made and 1 compiy with the <br /> i State Contrectors Law 18.27 RCW and 296200 WAC. <br /> ISignature of Owner/Contractor/Authonzed Agent Date — � <br /> �1�)� <br /> � <br /> ; - --_ _ _ _ _ ---_ ___ <br />