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P�RMIT AF'PLICATId� <br /> CITY OF EVERETT PF..RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-b810- FAX 425-257-8857-www.everettwa.org �l fl �d u <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NO"'ACCEPTED <br /> SITE ADDRESS PARCEL TAX I,D.# ��MIT Z ` �� <br /> I Q1 � MsRf��u cRrck �fKw/ <br /> LEGAL LOTNO. BLOCY TRACT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> INIEG2i�ltv �ElI,�N�L���' 19i0Ma�SRi« <R�e,t EvcF=ri wA98z�3 <br /> ' z � a38s <br /> TENANT NAME I CONTACT FOR PERMIT PH NE <br /> ' WO� I � � � ZS 78 7 2 c�8 � <br /> CONTRACTOR ADDRESS CITYrIP PHONE <br /> CONTR.LICENSE# �� ,`� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> ,��t �� � ,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NQ. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Porcec'air syslems <br /> Lavalory (wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas Tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink (service/bar/mop/elc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fount2in Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SA'.ES TAX CODE IS 3105 <br /> � I hereby ceritify that I have read ana examined this applicatic� and kno�v ihe same to be true and correct. All provisions of laws and <br /> Iordinaces goveming this type of�vork will be complied wi!h whether spec;fied herei�or not.The granting of a permit does noc presume <br /> lo give authonty to violate or cance!the provision of any olher state or local la�v regulating conslruction or the performance of <br /> I construction. That I am authori>ed by the owner of this property to perform the work for which application is made and I comply with ihe <br /> I State Contrectors .� 18 ' 7 RCW d 296200 WAC. <br /> � ZSSFPoy <br /> Sign ture of Ownyr� ct Authonzed Agent Dale <br /> I _ �Iv <br />