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� P�RMIT APPLICATION <br /> CITY OF EVE�ETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 j -� �'�y <br /> � 425-257-8810 -FAX 425-257-8857-wv✓w.everettwa.org <br /> I <br /> APPLlCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARUS ARE NOT ACCEPTED <br /> SiTE ADDRESS PARCEL TAX I.D.# P�RMIT# <br /> � o a si8 �� azov !_; ���-- �U <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE C� f�[(Q-/7 7 <br /> S�ea�It'�,s� �o��/u„'�� aa Y// .�., f3:.r! 5�,�•/ N�Su.�t �.� PY.2 -�sa�[77 u <br /> TENANT NAME I CONTACT FO.R PERMIT � � P ONE <br /> .r� /7�� /7<t�i � (JCy�.' a � �Qr �O S ��el 7as- S��i 3'��S <br /> CONTRACTOR � � AO�RESS CiTY21P PHONE <br /> 5b De,�a,� z.�x ���r ��� Nc �•�s� �Y-yoo� <br /> CONTR.LICENSE# D //��C � � �- <br /> s p D�q cc..,��1 f�v r Ste aoo� '�- , � <br /> USE OF BUILDING ' HEAT SOURCE I CONTRACT PRICE OF WORK <br /> TP�I�PNt '�"y0r0ur�c�` _Electric _Gas_Olher ,�� �0� <br /> i <br /> WORK DESCRIPTION <br /> � - �Ot �� Y'" ���0 n a� <br /> PLUMBING MECHANlCAL <br /> NO. TYFE OF FIXTURE OR ITEM N0. NPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) _ Gas pipin9 <br /> Shower 'Nater heater <br /> Kitchen sink&disposal _ Gas fre��ace <br /> Dishwasher Gas rai�ge <br /> Clolhes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/moplelc.) _ Exhaust fan <br /> BackOow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> � = Floordrain = Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olhcr — <br /> CI7Y OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby ceritify that I have read and examined lhis applicalion and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied�iith whether specifed herein or not. The granting ot a permit does not presume <br /> to give authoriry to violate or cancel the provision of 2ny other state or local law regulating construction or the performance of <br /> construc!ion. Thal I am authorized by lhe owner of this property to perform the work for which application is made and I comply wilh the <br /> State Contractors Law 18.27 RCW and 296200 WAC. <br /> SignaWre of Owner/Contractor/Authorized Agent Date � <br />