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PE�tMIT APPLICATI��J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-.:07-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 3 CREDIT CARDS ARE NOT ACCEP'TED <br /> SITE ADDRESS � PARCEL TAX I.D.if PERMIT M <br /> /` , S ` ✓P�P I'V105o 3-0 3 7 <br /> I.EGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER J� � AODRESS CIlY2IP PHONE�yy�Sg�S�-y/o/ <br /> J�P✓P/'l �l/ /fi/�71°!/ �.��/� ���FGI� hynnctiboo�9�'a37 � �/�57y�-.Z�i z <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR ADDRESS CITV2IP PHONE <br /> CON1R.LICEN3E N D�. n��� <br /> /V` <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � Electric _Gas_Other <br /> WORKDESCRIPTION ���.�P /f�'uJ �<,���Ji�C' �D /i�f/nce in�'s:•^I J �C� — /J�'�c16z5 �'�°r /" <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> Toilet A/C-air handling units <br /> _ Bathtub Forced air systems <br /> Lavatory(wash basin) �- Gas piping <br /> Shower � Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sfnk(servicelbar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Bollar <br /> Floordrain Refrigeratlon <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7AX^.ODE IS 3105 <br /> I hereby ceritiy that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied with whether specified herein or not.The grantlng of a pertnit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law rcyulaUng construction or the performance of <br /> construction.That I am authorized by the owner of this property to perfortn the work for which application is made and I comply with the <br /> State Contra�s Law 1 CW and 296.200 WAC. <br /> � 3 � GS <br /> n re of Owne ntractodAuthorized gent te <br />