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- _ _ � <br /> PE.IMIT APP�ICATIO�J I <br /> CITY OF E!lERETT PERfVIIT SERVIGES <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.# PE IT# <br /> / <br /> //,��f 5C� ���t�c•rr /�rac� LG:s� . �_ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AD�RESS CITY/ZIP PHONE <br /> � j, <br /> T3TJ��r �� �c. ti'�c:�� �TL`�-lo_Jh-Hsr �" �4�wc�l 7�-: <br /> TENANT NAME I CONTACT FOR PERMIT / PHONE <br /> ,�7 ---� 1 <br /> `��<�n,c ��l /�oIL'u" IC��� I !7�'Y�� �J ���/L� -/C�ISO�J �F.C� JI�'�� �j`� � ��%��lC� <br /> CONTRACTOR ADDRE55 . CI7Y21P PHONE <br /> S� �u��CO��� <br /> CONTR.LICENSE# �������qi,�;�A <br /> ll <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas_Olher �..)c7 ��U <br /> WORK�ESCRIPTION <br /> � <br /> ��F��2���1��� ��✓ObL�C��T1U'L� – ,�c'.:���v�-1C a� �3 %��.'ivc, �(-lKau��� � iti�rS <br /> ) i <br /> i��C)/a: �� ._,iLdc �v�c.�� �j�.U�:-�21f ` j�Z/nJa;� -So�F,� i�LViS�ou <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathb�b Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Showar Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> � � Sink(sa,rvice/bar/mop/etc.) Exhaust fan <br /> IBackflow preventer Heat pump <br /> � Urnal Unit heater <br /> � _ Drinking Fountain _ Boiler <br /> Floor drain Refrigeraticn <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> I — — — <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinac�s governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give a�thonry to violate or cancel the provision of any olher state or local law regulating construction or the perFormance of <br /> construction.That I am authorized by the o•.vne�of this property to perform the work for r�hich application is made and I compty with the <br /> State Cor�trzctors Law 18.2,7�F�W and 296200 WAC. I <br /> � r `���������—yi �����-�-% !c� b Cy � <br /> 5igr��tur of OemerlConiractodAuthorized Agent Date �/� <br /> I <br />