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PL�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.everetriva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.� <br /> �� 15 �ra ti�i /��C. PERMIT/ <br /> LEGA LOTNO. BLOCK TRACT � Z <br /> DESC. <br /> OWNER ADDRESS <br /> Q / ITY21P PH N <br /> Q��� � � c� U !'IUQt.� �g .2g �tiC�oV �vNYr� <br /> TENANT NAME I CONTACT FOR PERMIT <br /> PHONE <br /> coNTRACTOR r'�s�� � 1-GcSS <br /> O t�N 6`/L �DRESS I CITY2IP PHONE <br /> CONTR.LICENSE K S c`c q ijoU � <br /> USE OF BUILDING HEAT SOURCE <br /> / CONTRACT PRICE OF WORK <br /> ry� ~� �Electric _Ges_Ocher ��� `� <br /> WORK DESCRIPTION ` <br /> �� — r'Cw�- <br /> PLUMBING MECHANICAL <br /> N�• TYPE OF FIXTURE OR�TEM <br /> NO. TYpE OF FIXTURE OR ITEM <br /> _ Toilet <br /> _ Bathtub _ a�-air handling units <br /> _ Lavatory(wash basin) _ Forced air systems <br /> ,_ Shower _ Gas piping <br /> _ Kitchen sink 8 disposal _ Water heater <br /> _ Dishwasher _ Gasfireplece <br /> I _ Clothes was�ier ._ �ag�nge <br /> � Laundry tray _, Clothes dryer <br /> I _ Sink(service/barlmop/etc.) = Range hood <br /> _ Backflow preventer _ Exhaustfan <br /> _ Urinal Heat pump <br /> _ Drinking Fountain _ Unit heater <br /> I _ Floordrain _ Boiler <br /> _ Grease trap ._ Refrigerdl(on <br /> I = Roof drains = �'�dstove <br /> Other Othar <br /> �� <br /> I� CITY OF EVERETT LOCAL SALES 7AX COOE IS 7;OS <br /> I hereby ceritify that I have read and examined this applicaUon and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The grantlng of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating ccnshuction or the performance of <br /> iconsiruction. 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 /> Slate ntra tor/aw 18.27 RCW at�d2g6.200 WAC. <br /> � � /�/ <br /> �t� �' ' ��- <br /> I� Signature of Own ontractor/Auth zed nt <br /> , Da e <br />