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P�rZMIT APPLICATIG�J <br /> CITY aF �VERETT PERMIT SERVICES <br /> 32U0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— F,4X 425-257-8857 —www.everettwa.org (� _� �,oS� <br /> APPLICATIONS ARE ACCEPTE'D FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE A�DRESS PARCEL TAX I.D.# P MIT i� <br /> //OB /,'����f�.i%. ,� Z.��� , ����.o y,Soo ,— _S <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> / r �(/(/ �/Y: <br /> � �v� !�/ff� / `�?)-� �>'rc� Or. SL• j��a�nMlJ'! �c`'L�6 .��) :•�-/ <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> /,n/ / r / '/ <br /> \ n�� /�/ i�� ��i,l J��� J O�T <br /> CONTRACTOR ADDRE55 � CITY2IP PHONE <br /> CONTR.UCENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> . � <br /> �i ��� ? ,,�!<<. �'" "�"�,�u � � Gas Other � � , �7 <br /> / 1 :> � !--�•, , I i � _Eiectric — — � ,�. <br /> WORK DESCRIPTION j <br /> /yR ..��,'�' .� (JO ��I� �c'_�"�iC `'G� Il, �a,��c.N in. i � G•� �� �r ���5� <br /> i <br /> � � <br /> � O�' �,<, i�� �,: ''I t`II� <br /> PLUMBING MECHANICAL <br /> MO, IYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel _ A/C-air handling units <br /> Bathtub Forced air systems <br /> >; Lavalory(wash basin) _ Gas piping <br /> � Shower Waterheater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Cbthes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> - Sink(service/bar/mop/etc.) � Exhausl fan <br /> B3ckflow prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grc ase trap Woodstove <br /> Rocf drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I hava read and examined this application and know:he same to be We and correct. All provisions of laws and <br /> ordinaces governinc� this type of work will 6e complied with wheiher specified herein or not.The grenting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating consWclion or the performance of <br /> construction.That I am aulhonzed by the owner of this property to perform the work for which application is made and I comply with the <br /> Stale Conlractors Law 18.27 R W and 296.200 WAC. <br /> ��.. �� �r/r/_ <br /> Signature of wnedContrector/Aulhorized Agent Date <br />