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, <br /> P�rtMIT APPLICATI(Si�l <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> ��O( 425-257-8810-FAX 425-257-8857-www.everettwa.org '� ..�Z ..p� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDR CARDS ARE NOT ACCEP'TED <br /> SITE ADDRESS PARCEL TAX I.D./ rt � <br /> �OQf �aJ � _ � ?�4S <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> �ir/d -,�'��v� �'��ih�ivs3; � /��,�r' 99�E GY,cwk/�,� <br /> TENANT NANIE I CONTACT FOR PERMR PMCME 9f�(,� <br /> 4G�N� /c�+�- <br /> cor�rw�cmn �� �oo�sa cmrmP M+o�+e <br /> CONTR.LICENSE M �,,5 ,l1a�L ���) sas�/�D� <br /> USE OF BUII.DING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _ElecMc _Ges_Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FDfTURE OR IfEM <br /> Toilet AIC—alr hendlirq unita <br /> Bathtub Farced air syatems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Water hseter <br /> Kitchen sink 8 disposal _ Gaa flreplece <br /> Dfshwasher Gasrange <br /> Clothes washer Clothea dryer <br /> Laund tra _ Rangs hood % / <br /> '� Sink(servicelbar/mop/etc.) _ Exhauat fan l � � <br /> Backflow preventer _ Heat pump �1 <br /> Urinal _ Unit heater <br /> Drinking Fountain Bofler � / <br /> � Floor drain _ Refrigeratlon <br /> Greaso trap _ W°°dato�e <br /> Roof dreins Other <br /> Other <br /> CITY OF EVERETT LOCAL SAlE3 7Al(COOE IS�105 <br /> I hereby ceritify that I have road and examined this applicatlon and know the same to be true and correct. All proviabna of lawa and <br /> ordinaces goveming this type of work wili he complied with whather specifled herein or not The prantlng oi a pertnit doee not proaums <br /> to give authority to violate or cancel provision of any other state or lacal law regulabng consWctlon or the psr(ormance of <br /> construction. m authorize y e owner of this property ta pe rm the work for which applicetbn ia made and I eamply with the <br /> State C ctors law 7 d 296.200 WAC. <br /> �� l� � <br /> Signamre o wnen ontracrod honzed Agent ate <br />