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PL��MIT APPLICATId�d <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88�0— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREOIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> � D c �_Sd.3'C.YJ7 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> .� � � _ // �tLSI-,xz <br /> � C—/!_i'Y� W (��2��5 �IoOG�Or,Ltlol/.�� �_!.C-r-�lis�d-k• <br /> TENANT NAME CONTACT FOR PER PHO E <br /> CONTRACTOR ADDRESS C�TY2IP PNONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Ges Other <br /> WORK DESCRIPTION <br /> ���/s� S�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NQ. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(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(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigere0on <br /> Grease trep Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX COOE IS 3105 <br /> I hereby ceritify thal I have read and examinod this applicatlon and know lhe same to be lrue and cortect. All provislons of laws and <br /> ordinaces governing this lype of worlc will be complied with whether specified herein or not.The granting of a pertnit does nol presume <br /> to�ive authority to violate or cancel the provision of any olher state or local law regulatinc�constructlon or the performance of <br /> construction.That 1 am authorized by the owner of this property to perfortn the work tor which application is made and I comply with the <br /> State Contractors aw 1827 RCW and 296.200 WAC. <br /> C����'1��.���� ��i�� <br /> Signature o OwnedContrectoNAuthonzed Agent Dale <br />