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PL�rLMIT APPLICA u�Cu�u� <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVEREfT,WA 98201 <br /> 47_5-257-6810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBR 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> o s� r`�-�-rr �c- w Sr r� a co�. <br /> LE LOTNO. RLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS ' CITY2IP PHONE <br /> TENANTNAME CONTACTFORPERMR PHONE <br /> �b i� Acc� �b`S I K��1� ���"�`J' y�S'. 33�-�/6 � <br /> CON7RACTOR � ADDRESS CITY2IP PHONE 2S 330�/(,� <br /> �nT Si bnl S�VCcC.� ^ � `��a a,.-,�.� �� ►-�,•y ��a�5 ����c �.��x. w.q-. s��, Z <br /> coNrn.uceNse a <br /> t�t3Ts�S� �iq Oi� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �v�'(_ Eleclric _Gas_Olher 3 ���� <br /> WORK DESCRIP710N <br /> �,�5�� G,�/Yt,�c. sr6�,/ /h�� /%oo�� �r/' 7D �-�s77,v�, ��..�t�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bafhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Ktclien sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Cblhes dryer <br /> Laundry t2y Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Un(t heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SILLES 7AX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined lhis appli�.atlon and know the same to be irue and coRect. All provisions of laws and <br /> onlinaces goveming lhis type of work will be complied with whether specfied herein or noL The granling of a pertnit does not presume <br /> to give authority to violate or cancal the pravision of any other state or local law regula6ng construcGon or tho performance ot <br /> construclion.That I am author¢ed by tha owner of this propeAy to pe�tortn the work for which application is made and I comply wilh lhe <br /> State Contractors Law 10.27 RCW and 296.200 WAC. <br /> � � � � ii <br /> Signature o OwnerfContractor/Au orrzed Agent ' Date �I� <br />