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PEr2MIT APPLICATIOni <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& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS /O ��/� �,! PARCEL TAX I.D.# PERMIT# <br /> � 5�3 -S <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. ' ����� . <br /> OWNER ADDRESS CITY2IP PHONn ` � '/A� <br /> y ( �! <br /> �J-� s c� � tt�o,� ,� �. �o.�� 22� f� y1J���^��f0 <br /> TENANT NAME —� CONTACT FOR PERMIT PHONE <br /> ��c��...�' I G�� y S �.� e sso� !I y�S 3 Y3��3 6 <br /> CONTRACTOR�r- � ADDRESS ITY21P PHONE <br /> 1Jess�/� �rk'k�/� <br /> CONTR.LICENSE#�/`SS� � / O ry(��/� /��jL�`'`JS` <br /> a o i� <br /> USE OF BUILOING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ElecMc Gas Other <br /> WORK DESCRIPTION <br /> � md j-I���s� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air hand�ing 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 Gasrange <br /> Clothes washer Ciothes dryer <br /> Laundry lray Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Backtlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Uloodstove <br /> Roof drains Other <br /> Other <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS J105 <br /> � I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> Iordinaces governing this rype of work wiil be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to viciate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am aut vrized by the owner of this property to perform the work for which application is made and I comply with the <br /> ' State Conlra�to Law 1 RCW and 296.200 WAC. <br /> i � � �_ �� � Q ) <br /> Sig u of r o tractor/A�ih iz d Aqent Date <br /> � <br />