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_—, <br /> PEI2MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � a _�c�_o<� i <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-II857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ����� ���� _ <br /> SITE ADDRESS PARCEL TAX I.D.# I PERf�717# <br /> 5� ,�����.r,�i/��da� - � -i�� ? � `�,�812Uc� <br /> LEGAL LOT N0. BLOCK �TRACT OR SUBDIVISION# --- <br /> DESC. <br /> OWNER A�DRESS CITYIZIP PHONE <br /> ,� -�i,9��� C�/��r��i�i�!<< �f Y3 y�s7��i�c°��� �yi�,����� C,,� �����oa% <br /> TENANT N,\ME CONTACT FOR PERMIT ., P��/C J��I' � <br /> �lJ/�,.�1�i%7l Gf�'�L'Y��9l�lr��/L ���/'�(�,W�i'� �i..E•MAIL <br /> CONTRACTOR ADDRESS CINIZIP PHONE <br /> ��< <���� �1,����i�r �/'�,��ut����; s�rr��f- l.r �rl��-y� <br /> C NTR.LICENSE � <br /> USE OF BUILDJNG I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �/ ./ ' � <br /> �� �i/ ��t �tlectric Gas Other ��y°O <br /> WORK DESCRIPTION <br /> � <br /> I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Balhtub Forced air systems <br /> / Lavalory(�vash basin) _ Gas piping <br /> Shower Water healer <br /> � Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater kange hood <br /> Sink(service/bar/mop/etc.) Exhaust(an <br /> BackOow prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> I = Grease lrap Woodstove <br /> Roof drains � Other C���N i P'iS GY <br /> I _ Olher _ � i r//�,. l�7_ . <br /> . CITY OF EVEI2ETT LOCAL SALES TAX CO�E IS J105 <br /> I hereby ceri6fy thal I have read and examined this appl'cation and know lhe same to be true and correcl All provisions of laws and <br /> ordinaces qoveming this type of work will be complied��itl?�vhether speci(ied I �rein or noL The granting of a permit does nol presume <br /> lo give authoriry to violale or cancel the provision of any olher slate or local law rec�ulating construction or the performance of <br /> wnstruction.That I am aulhorized by the owner of this property to poAorm the work for which application is made and I ccmply wilh the <br /> State Contractors Lav+18.27 RCW and 296.200 WAC. <br /> � .�- �> s ���i�/� � � <br /> Signature o(Owner n actor/Authorized Agenl Dale <br /> �— -- — � <br />