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P���MIT APPLICATIO�v <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 AR� ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAJC I.D.N PERMIT N <br /> 26os C. ���,nJ ��� _ � -ov-7 <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> C�l,�f2rCe. u�e�--�- 2��Z E. �iG� f��e. C-UQ�Re�" I�L'�J� CyZs� zSZ- ��2� <br /> TENANTNAME I CQNTACTFOR PERMIT PMONE <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric ,�Gas Other <br /> WORK DESCRIPTION i <br /> r <br /> ,,yt od c-+' �� ��Gc�/�� <br /> PL MBING MECHANICAL <br /> NO. TYPE OF PIXTURE 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 /> _j__ Kitchen sink 8 disposal Gas fireplace <br /> � Dishwasher � Gas range <br /> � Clothes washer Clothes dryer <br /> _ Laundry tray � Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal _f— Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 7103 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and corted. All 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 authority to violate or cancel the provision of any other state or local law regulatlng construcUon or the perfortnance of <br /> construction.That I am authorized by the owner of this property to perform the work forwhich application is made and I comply with the <br /> State ontracrors Law 18.27 RCV�f_and�.200 WAC. <br /> I /�G`i-y+'t�C". ��� / � � �- I�i-U`f <br /> Signature of Owned ontractodAuthonzed Agent Date � l <br /> �� <br />