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PLrtMIT APPLICATIG�� <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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADORESS / PARCEL TAX I.D.A� PERMI ht��/'�/' <br /> 72 � , %!G Cv�,-c f` �.JCf/ �� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHOkE y�� <br /> �-f/.` ������ �7,z � �i� c E,��,cf� 9�z�/ �,T9 /7% <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY/LP PHONE � <br /> s�j�,rq � '✓on�C�� � <br /> CONTR.UCENSE N y�� �39 ��y� <br /> USE OF BUILDING p _I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��G�� �70� Electric Gas Other <br /> WORK DESCRIPTION <br /> ���/t ��� /%va��/ L.�,�l� <br /> 2Zx8' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> Tailet AIC–air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Cas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> D(shwasher Gas range <br /> Clothes washer Clathes dryer <br /> Laundry tray � Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pumn <br /> Urinal Un(t heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trep Woodstove <br /> Roof drains Other <br /> Other <br /> C�TY OP EVERETT LOCAL SALES 7AX CODE 19 3105 <br /> � hereby ceritiry that I have read and examined this appllcaGon and know the same to be true and correct. All provisions of laws and <br /> � ordinaces governin9 this type of work will 5e complied with whether specifiad herein or not.The granUng of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulatlng constructlon or the perfortnance of <br /> construction.That I am authorized by the owner of this property to pertorm the work far which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> Y ��''�--- �/�,--��� /O-OI� <br /> gnature of OwnerlContractoqAuthonzed Agent ate � <br /> � .��-.�� O " r e/, Il <br />