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PL�2MIT APPLICATICi��I <br /> CITY OF EVERETT PERMIT SERVICES <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 R CREDR CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.f P RMIT/ <br /> ! ��� N�w, �f" uil -a3 � <br /> L=GAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER - ADORESS CITY2IP PM NE <br /> ���e f�l�� �6 %��x ZzzB� ��-e �'��z <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 2U�e 33z - or� <br /> CONTRACTOR /(��/ � ADDRESS CITY2IP PHONE <br /> � z <br /> CONTR.LICENSE K <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electnc Gas_Other <br /> WORKDESCRIPTION h� n _�� <br /> �G iCQ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM NO. TYPE OF FL."TURE OR ITEM <br /> � _ Toilet _ A/C—airhandlingunfts <br /> I _ Bathtub _ Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> I = Shower _ Water heater <br /> Kitchen sink&disposal Gas flreplace <br /> Disr asher Gas range <br /> CloVes washer Ciothes dryer <br /> Laundry trey Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Unnal UNtheater <br /> Drinking Fountain Bo(ler <br /> � Floor drain Refigeratlon <br /> _ Grease trap Woodstove <br /> V Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS J105 <br /> j I hereby ceritiry that I have read and examined this applicatlon and know the same to be true and correct. Atl provisions of lawn and <br /> ordinaces goveming this rype of work will be complied with whether specified herein or not The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating constructlon or tha perfortnance of <br /> construction.That I am authorized by the owner of this property to perform the work for which app�icatlon is made and ' comply with Ne <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> I � ' Z�l°� <br /> Signature of OwnenContractor/Aut onzed Agent ate <br />