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�- cRMIT APPLICATI�JN <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.# PE IT M# <br /> r Cl . �, , � . l.� �Z <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PNONE <br /> � �' L A <br /> ���J ���� l2 r � � � �►�,c. �c. [� �� �v; �,..����I� Gtrt�tf� �? <br /> TENANT NA CONTACT FOR PERAIIT PHONE <br /> I � r �� �<< � (7C-o�o?- 'j � <br /> ��IJ al� � t� ���JN.Q ��y ,��v� '+� LI 5 <br /> CONTRACTOR\ i�u{7 ��� �µ iC� ADDRE55 CITY2IP P ONE <br /> �l ']3GI 7��" S� �_ P lJ�o-1�S� I� 'P V�J� � 1�lV <br /> CONTR.LICENSE# <br /> �i ON IJG L�7�N+.tC� <br /> USE BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �,p��`� p,NC �i �,Electric _Gas_Other £yf�U�� �J <br /> WORK DESCRIPTION--� I (l <br /> �e.wteJ�� � c7��* �uoi,N` Mad �(-�qp� NP.�V . <br /> 3� y � � � � � � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handlina units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Sho�ver Water healer <br /> Kitchen sink&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 /> = Backflwv prevenler Heat pump �I , <br /> Urinal Unit heater �� <br /> _ Orinking Fountain Boiler / '`k <br /> _ Floor drain _ Refrigeration (�{"1 <br /> Grease trap Woodstove J <br /> I = Roof drains = Other <br /> Other <br /> i GTY OF EVERETT LOCAL SAlES TAX CO�E IS J105 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of�vork will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authonty to vi te or cel th "rovision of any other state or local law regulating construction or the performance of <br /> construction. Th �rn au onzed the owner of this property to perform the work for which application is made and I comply wilh the <br /> Slat o trec rs-Law 1 RC and 296.200 WAC. <br /> ; � 2 � J � <br /> S ur Ownen actoiAuthonzed Agent Date <br /> � <br />