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PE�r2MIT APPLICATIO�J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 �EDAR STREET, EVERFTT, 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.# PERMIT# <br /> �2 E C ��� a�� _ <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE � �S <br /> _�JeSSc, (�isc�U� ZzY E /Y)c¢;11 au2Fv�erPfT9g2oe 7S'o-91 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �' I �P�Se. �Svv1U� ��f2t� �So-a�78 <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> CONTR.LICENSE I{ OW 1 1-Q r <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _ ��s,,d�,�e Electric VGas Other <br /> WORK DESCRIPTION <br /> �aS e� <br /> I/�5-��I��r -�trc�)9�ei WR�� (Zatnyt GyY70� �C��15 Pil9i✓�✓ <br /> 1 <br /> PLUMBING MECHANlCAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—afrhandling�nils <br /> Balhtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Show�a� ater heater <br /> _ Kitchei�sink&disposal Gas fireplace <br /> _ Dishwasher as range <br /> _ Ciothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mopletc.) Exhaust fan <br /> Backflow preventer Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain Builer <br /> _ Floor drain Refrigeration <br /> Grease trep Woodstove <br /> Roof drains Other <br /> Olher — <br /> . CITY OP EVERETT LOCAL SALES 7AX CODE IS 3705 <br /> I I hereby ceritify that I have read and examined lhis application and know the same to be We and correct. All provisions of Iaws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulating constructlon or the perfortnance of <br /> ' consWction. That I am authorized by the owner of this property to perform the work for which application is made and I compty wilh the <br /> Sl2te Contractors Law 18.27 RCW and 296.200 WAC. <br /> Signature of Owner/ContractorlAuthonzed Agent Date <br />