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P��MIT APPLICAT�iG�J <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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# pER A <br /> /Cv /<o /11 a /e S-f- <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PFiONE <br /> Y2t- .23i- 4J4z <<�/ <br /> �Gr�y � f�n;�q �4na /�l�/l �9/< Lj.-e .✓_F /��/;.,,foa .�GO'43f- �AGS �(o..c <br /> TENAN7NAME CONTACTFOR PERMIT PHONE <br /> I �Grr ti1S- .23�- 436 z cc/� <br /> .itlf}' r C4�o 3Go� 43S- 9obs ho�c <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> Q�+-+n t� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> k Electric _Gas_Other ad S 0 U <br /> WORK DESCRIPTION <br /> Znf-�c�� /`�'c�c% 4rq,� — CafcS �qs,� — .Sc...� �4 ...� u.,�o. �d�y� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR�TEM <br /> Toilet A/C—air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> i Shovier Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Ciothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/elc.) Exhausl tan <br /> � Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease lrap Woodstovo <br /> Roof drains Other <br /> Olher .S�.w� �c.�n <br /> — � .— — <br /> CITY UF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined this applicaGon and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type oF work wili be complied with whether specified hereln or not.The grantinp of a permit does not presume <br /> to give aulhority t violate or cancel the provision of any other state or local law regulating wnstruction or the perfortnance of <br /> construction.That I am authorized by lhe owner of this property to periorm the work for which application is made and I comply wilh lhe <br /> State Contractors Law 1827 RCW and 296.200 WAC. <br /> �:�j �.�,- � -aS a�s <br /> Si nature of O edContractodAuthonzed Agent Date <br />