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PEr211111T ,�PPL�ICATIO�J <br /> CITY O� EVERETT PERM17 SERVICES <br /> 3200 :EDAR STREET, EVERETT. WA 98201 <br /> 425-257-881�;r— FAX 425-257-8857—w•n�w.everettw�.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 7L CREDIT CARDS ARE NOT ACCE�TEd <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT� <br /> 9;3 Fl a y r v£ �� Do�f,�70 3 7 0 � �o o -1� <br /> LEGAL LOTNO. rByLOCK hTRAC�T^ L t-y'� 1� '�? <br /> DESC. I / � f L� I C I �V�� Y l � I� �V � � � r � +-' <br /> OWNER ADDRESS —�TY21P ✓ :ONE <br /> (�o�. 5� 7-325 <br /> Rb$ ERT G, N6PcR.o F7— 5�3o F, GR ��N �frk� �vqy N, �EA- <E qS�s/o3 <br /> TENANTNAME CONTACTFORPCRMIT PHONE <br /> CONTRACTOR AUQi2ES� CITY2IP PNONE <br /> CONTR.LI.r.ENSE# <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF N'�RK <br /> _Electric �Gas_Other <br /> WORK DESCRIPTION <br /> D�I� o � � � N f�o� ,�• � <br /> PLUMBING MECHANICA!_ <br /> NO. NPE OF FIXTUkE OR ITEM NO. TYPE OF FIXTURE C;h ITEM <br /> _ Toilet A/C-alrhandlingunils <br /> I _ Bathtub _ Forcedairsystems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplaco <br /> Dishwasher ' Gasrange <br /> Clothes washer Clolhes dryer <br /> Laundry tray Rango hood <br /> Sink(serviceibar/mop/etc.) Exhaust fan <br /> Backtlow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Flocr drain RefrigeraUon <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SAIES TAX COOE IS 9105 <br /> I hereby ceritify that I have read and examined ihis applicalion ard know the same to be lrue and correct. All provisions of laws and <br /> ordinaces goverriing this type of work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> to give authonly to violate or cancel the provision of any other state or local law regulaling conslrucuon or the performance of <br /> cons;ruction.That I am authorized by the owner o(this propeAy to perform the work for which application is made and I comply with the <br /> State Contraclors Law 18.27 RCW and '296200 W <br /> ��.-P�..,��� �%-� 3�3//�S <br /> Signature of OwnerlGontractor/A thorized gent Dat <br />