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PL�rtMIT APPLICATI� <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&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.� ERMIT t1 <br /> � �/6 /�ecJi �i4�/�- DON3q/� �o�oo _ <br /> LEGA LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> P/�1°i-5 Isiucr or �'�' Za 6-726-0 4�/� <br /> CONTRACTOR �Q�'� �-��SA►✓�� AODRESS CITY2IP PNONE <br /> 6rc�a rzz'�.f1ce s Sc�.+n."d�P qy <br /> CONTR.LICENSE NO,r���y O��Q � � �Y��$' ���726`O � <br /> /� ��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> o'� <br /> Eiedric Gas Other ��.s� <br /> WORKDESCRIPTION���(��� � P�/'U eM �(L3d �2° SG( s �� <br /> $��i t-M <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTLRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Uishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove s�s <br /> � Roof drains Z Other Fi/'G SNP/•'� ��'� '��� <br /> I Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify ihat I liave read and examined this applicatlon and know the same to be true and cortect. AII provisions of laws and <br /> ordinaces 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 authonty to violate or cancel the provision of any other state or local law regulatlng wnshuction ar the perfortnance of <br /> Iconstruction.That I am authorized by the owner of this property to perform the work for which applicatlon is made and I comply with the <br /> State Contr�18.27�RC_j�We�����d�29.t6.200 WAC. ��� <br /> I �`7'wlJ� � d5 <br /> Signature of Owner� ontractoriAuthonzetl Ngent Date r/� <br />