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P 'RMIT APPLICATI�N <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 /> APPLICATt'1NS ARE ACCEPTED PROM 8 AM TO 4 PM � ..'�5�� <br /> SITE ADDRESS PARCEL TAI(I.D.N PERMIT A <br /> - � os �2.�� o A � � . Ao�oB� -oi7 <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP HONE <br /> �/��eK 2AF'��n /yOS C�P/�NO %� oe rU�rre� �(LS -7�S-f S <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR / ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE/ �C�U �"���� r C <br /> USE QF BUILDING I — HEAT SOURCE I ^'�NTRACT PRICE OF WORK <br /> � �,�,� , Electric ✓Gas Other <br /> WORK DESCRIPTION <br /> ��v.�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FUf7URE OR ITEM <br /> Toilet AIC—air handling units <br /> � BathWb Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Cbthes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> �C Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I havc read and examined this application and know the same to be true and correct. All provisfons of laws and <br /> ordinaces goveming this type ot work will be complied wilh whelher specified herein or not.The gra�ting of a petmit does not presume <br /> to give authority to violate or cancel the provision of any other stale or local law regulating constructbn or the pertortnance of <br /> constructi n.That I am authorized h the owner of this property lo perfortn the work tor which application is made and I comply with the <br /> State Co tractors� 18.27 RC a d 296.200 WAC. <br /> � �-ZS-O C <br /> ignaWre OwnedCon ractodAuthorized Agent Date <br />