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P�RMIT APPLICATIG�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> r 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& CREDIT CARDS ARE NOT ACCEPTED <br /> �ADDRESS PARCEL TAX I,D.# �j� <br /> - P/�'`(���� ` � <br /> LEGA LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER ADURE3S <br /> � I� /� �� CITY2IP PH NE <br /> w Gl.�/1 25 I�- Oa�S �lv�F. ve,�:e�4- ��I ���� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR � � ��'� �+���� ��—�`�" � <br /> �1 � ADORESS CITY2IP PHONE <br /> C,�M p�t'a�in g �q�5 �oacl►�a,.1� �vG� Qs2�� Cq2s�2�t -l�l�lv lv <br /> CONTR.LICENSE X� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric �( Gas Other <br /> WORK DESCRIPTION <br /> � ' � l�s� p��� C� <br /> PLUMBING/ <br /> MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C-airhandlingunits <br /> _ Bathtub � Forcedafrsystems -Tu�aaEl� <br /> _ Lavatory(wash basin) Gas i in <br /> Shower -�.- p P 9 _ ��L <br /> _ Kitchen sink&disposal —L Water heater <br /> Dishwasher _ Gas fireplace <br /> Clothes washar _ Gas range <br /> Laundry tray _ Clothes dryer <br /> _ Sink (service/bar/mop/etc.) _ Range hood <br /> Backflow preventer _. Exhaust fan <br /> Urinal _ Heat pump <br /> Drinking Fountain _ Unit heater <br /> Floor drain _ Boiler <br /> Grease trep _ Refrigeratfon <br /> Roof drains _ W�dstove <br /> Other _ Other <br /> I — <br /> i <br /> � CITY OF EVERETT LOCAL SALES 7AX CODE IS J103 <br /> I hereby ceritify that I have read and examined this applicatlon and know Ihe same to be true and corred. All provisions of laws and <br /> ordinaces goverr.ing 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;ny other state or local law regulatlng consVuction or the partortnance of <br /> c�^struction.That I am authorized by the owner of this property to pertorm the work for which applicaGon is made and I comply with the <br /> i Contractors Law 1 .�C and 296.200 WAC. <br /> i �.P�� p .�.�,. .; <br /> bignature of OwnedCo trecroqAuthonzed Agent ate <br /> \ <br />