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F �RMIT APPLICATI��� <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 NC1T ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> 211g oA1c�c5 �v� MoSo�-oo <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �k2S-Sal-\`Ey <br /> �N1t, A�l�5�.�o R-r l� Z l�S dRkrcS R� F��1��G�cY uJa4 �l g?A� <br /> TENANT NAME I CONTACT FOR PERMIT P NE <br /> _ bIAld1l6�� !b 11�OCcQ <br /> CONTRACTO ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � E'��������� 7�Electric Gas Other <br /> WORK DESCRIPTION � U��i S ��, 1 <� '�-o —�i�r2.PIa� ��nS21''�� <br /> b,,�,q�� -���1�.� ���� �,����- <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling unfts <br /> _ Bathtub Forced alr systems <br /> _ Lavatory(wash basin) � Gas pipfng <br /> Shower Water heater <br /> _ Kitchen sink&disposal � Gas flreplaco <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clathes dryer <br /> _ Laundry Vay Range hood <br /> _ Sink(service/badmop/etc.) 6chaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Fioor drain Refrigeratian <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETf LOCAL SALES 7AX CUDE IS 7105 <br /> II hereby ceritity that I have read and examined this application and knaw the same ta be true and cortect. All provis(ons af Iaws and <br /> ordinaces goveming this type of work wili be complied with whether specified harein or not The granting of a parmit does not preaume <br /> ro give authonry to viola or cancel the provision of any other state or local law raguladng consWcBon or the performance of <br /> ' construction. That I thorized by the owner of this property to perform the Hork for which app'!catlon is made and I comply with the <br /> iState Contrectors aw . CW and 296.200 WAC. <br /> Signature o nen tractorlAuthorized Agent Date <br /> I <br />