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P�RMIT APPLICATIG�V <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 PARCEL TAX I.D.# PER �M I <br /> oS �ba ' i/ <br /> LEGA LOT N0. BLOCK TRACT I <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE�Q�•L�� <br /> �Y'nt� �LOII� a lUS /�10N/ZDL_ ����7% Q�O.� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTO� rn ,F't/)-r�N� ADDRESS�� (I? CIr�21P PHONE <br /> "l ! ,�,�4pwA-Gf �U�7'T 4 S�1 <br /> coNrn.ucer,sG/Yt 1��(-�1�kb9512�/ � y�.s-�59��66 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric _Gas_Other d, 533 _�r0 � <br /> WORK DESCRIPTION <br /> �.cnJs7R� L ��eEP1.AC� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toiiet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal � Gas flreplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicnlbar/mop/etc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 9105 <br /> I hereby ceritify thal� have read and examined this applicatlon and know the same to be true and correct. All provislons of laws and <br /> ordinaces governing this type of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That�am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State ntractors Law 1827 RCW and 296.200 WAC. <br /> �� R�Sz��u,LF' �� �"C� <br /> Signature of wnenC tracto Authorized Agent Date <br />