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P�r2MIT APPLICATidnl <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.# PERMIT/ <br /> / G��wo �� oo v.3 �� o. o a osoa-oo � <br /> LEGA LOTNO. BLOCK TRACT � <br /> DESC. 3d,/ �y3 L�rrvf E�tT �ir <br /> OWNER qDDRES3 CITY2IP PMONE <br /> 90`lil� 9o.!/CS /`.��}7 G'r.�..o.t..e �'va.r.�" �,S-7 - //�5' <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR�/p/T1twe-!T �M.►j�S ADORESS��,�eX 3�0 ���y/�p PHONE <,lZS <br /> ���.����s 3_�y SLL <br /> CONTR.LICENSE• <br /> tio��� ,�y�a �/r�l� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WOkK <br /> �' � _Electric _Gas_Other Z ��� v o <br /> WORK DESCRIPTION � � <br /> / <br /> X�2 G/�i�i L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYPE OF FIX7URE OR ITEM <br /> _ Toilet AIC—air handlfng units <br /> _ Bathtub Forcedairsystems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal Gas flreplace <br /> _ Dishwasher Gas range <br /> _, Clothas washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain RefigeraUon <br /> _ Grease t2p Woodstove <br /> Roof drains Other <br /> Other <br /> � CITY OF EVERETT LOCAL SALES SAX CODE IS J705 <br /> II hereby ceritify that I have read and examined th!s applicatlon and know the same to be true and conect. All provisions of laws and <br /> ordinaces goveming this rype of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> ito give authority ro violate or cancel the provision of any other state or Iocal law regulating constructlon or the perfortnance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> I State Contr ct rs Law 18.27 RCW and 296,200 WAC. <br /> � �%`�a.�s�s�c �-3�- �— <br /> � Signature of Ownerl ontractodAuthorized gent ate �L <br /> I <br />