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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.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL T/U(I.D.A� PER / <br /> ' i - A�' _ .�f �l0 5.3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CiTY21P PHONE <br /> �� mC!°n'C -W i/�^'� � o <br /> TENANTNAME I CONTACTFORPERMR PHONE <br /> A/�i4 <br /> CONTRAC OR ADDRESS CITY2IP PHONE <br /> Art�sa,ti Renou�.�ss ��� � 3�-�c}f. N.w ��.,,,,,�caf, t.�it- � � <br /> CONTR.UCENSE N <br /> �4ATi � Ks ss/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT ICE OF WORK <br /> J �R �Eleclric _Gas_Other ��� � <br /> WORK DESCRIPTION <br /> 1� `►�' <br /> y— <br /> I� - l d Lt�'Gt�v' � ltili`�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR 17EM <br /> �� Toiiet A/C-airhandlingunits <br /> /� BathWb Forced afr syslems <br /> /_ Lavalory(wash basin) Gas piping <br /> _� Shower Water heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Cbthes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaust fan <br /> _ BackOow prevenler Heatpump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floordrain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicaGon and know the same to be true and cortect. All provfsions of laws and <br /> ordinaces goveming this type of work will be complied with whether specifled herein or not.The granting of a permft does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulaBng construction or the perfortnance of <br /> construction.That I am authorized by the owner of lhis property to perform the work for which applicadon is made and I compty with the <br /> State Conlractors Law 1827 RCW and 296.200 WAC. <br /> �C�, �i<�'l�� 6�8/cs <br /> Signalure o ned ontractor/Authonzed Agent ate �L <br /> /7� <br />