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PEi.MIT APPLICATIOIv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAF. STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> � a — �3 —o5 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8� CREDIT �:ARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P IT� <br /> e ���/�-.�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Pa�;�k �XI �,� ��n� �..o��.,��v��- asz�� C�Z� z►�-����i <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> C.tv� �a�� <br /> CONTR.LICENSE# <br /> �,rv� Nr-_ 14T C�(1gQ8 141� '��n��'�u Lv�r��42.n� Cyz51z5'i-b�l��. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric �Gas_Other <br /> WORK DESCRIPTION <br /> :u�� o-c,`"� �1� �� �'-� �� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling unils <br /> Bathtub � Forced air systems <br /> � _ t:+�z•'-�y(wash basin) � Gas piping <br /> Water heater <br /> _ _ . ... ;ink& disposal Gas fireplace <br /> _ G�si , ,aher Gzs range <br /> i _� Clothes washer _ Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backilow prevenler Heat pum(� <br /> Urinal Unit heater <br /> I Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap VJoodstove <br /> Roof drains Other <br /> I _ Other _ <br /> CITY OF EVFRETT LOi:AL SALES TAX CODE IS 3105 _ <br /> iI herehy ceritify that I h2ve read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be compliad wilh�vhether specified herein or not.The granting of a permit does not p�e�ume <br /> ito give authority to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br /> construction."i hat I ain authorized by the owner of this property to perform the work for which application is made and I comply evith the <br /> � State Contraclors Law 18.27 R W and 296.200 WAC. <br /> �CL%Zl?(�-lf X 1�,��n �lrt �l �'�� "�- <br /> I Signature of Owner/Contractor/ horized Agent Date <br /> I <br />