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F'��RMIT APPLICATit�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> �9io -�z� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM l'O 4 PM - DEBIT& CREDIT CARDS ARE OT ACCEPTED <br /> SI E ADDRESS PARCEL TAX I.D.# E IT# <br /> -1 F_'v�Q �� �JAU ogil -o/i <br /> L�GA LO NO. � BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONE <br /> �/ <br /> 1��r����� �li I �nSSAN � ah��-� � J rri <,� q�a��� <br /> TENAN� / CONTACT FOR PERMI7 PHONE <br /> ��-�t.� ��l �I I I�IG 1iln �l �El��1,/ �Zs= 3�fS=�5�/2 <br /> CONT� � AD�RESS CITY2IP �PHONE <br /> ���C%an-- ��'n �_�1- � � �17- �'�I n:y�. �GZ �D ��/�-�r lT� �/�, � <br /> CONTR.LICENSE# ���� �� �� � �� ����� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR IiEM � <br /> � Toilet AIC—air handling units <br /> Balhtu6 Forced air systems <br /> :1 Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br />' Sink(service/bar/mop/etc.) Erhaust fan <br /> � Backflow preventer Heat pump <br /> .rr , Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> � Floordrain Re(rigeralion <br /> I _ Grease trap _ Woodstove <br /> i = Root drains = Other <br /> Other <br /> I CITY OF EVERETT LOCAL SALES SAX CODE IS 7�05 <br /> I� I hereby cerilify that I have read and examined this application and know the same to be true and correct. All pro�isicns of laws 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 authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> constr,uction.That j am aulho zed by lhe owner of this property to perform the work for which application is made and I comply with lhe <br /> StaieG'ontractors aw, 18.27 �W and 296.200 VVAC. <br /> I r��" �,� /�� � � �����" ��G��� <br /> Siq jeture`o wneqCont e or/Authonzed Agent Dat <br />