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PErtMIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.uverettwa.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.# PEQR,M� IT# <br /> ll L�t� I ti�rfvZ.•S�L' 4J✓a'�'�—!� i ��1Q 0�1� IISOUc���Of'i7 Lil'1� �'�Z4 <br /> LEGA 1.0T N0. BLOCK TRACT <br /> oesc. E�S Irnoi N <br /> OWNER ADDRESS CITY2IP PHONE <br /> (`tarce.l; nal D�,I�,d,'�; i��n � � �.-�c . 5•c . �=✓ua.� 4vN �8�a' �4�a-w�3ory <br /> TENANT NAME I CONTACT FOR PERMIT pHONE <br /> H /p Mt�,EuNn 0nwuor4 �fl,i _ vb77o ry� <br /> CONTRACTOR hDDRESS CITY2IP FI10NE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � Electnc Gas_Other <br /> WORK DESCRIPTION <br /> ��� �,� ��� <br /> � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> 2 Toilet A/C—air handling unils <br /> t Bathtub Forcedalrsystems <br /> _,i Lavatory(wash basin) Gas piping <br /> � Shower � ater heater <br /> � Kdchen sink 8 disposal fireplace <br /> � Dishwasher Q Gas nge <br /> � Clothes washer ,� Clothe ryer <br /> � Laundry hay __(_ Range ho <br /> Sink(service!badmop/etc.) ,�, Exhaust fan <br /> � Backflow preventer � Heat pump <br /> � Urinal � Unit heater <br /> '� :Drinking Founlain ` � Boiler <br /> I � Floor drain ___[_ Refrigeretion <br /> � Grease trap � Woodstove <br /> ' Roofdrains Other Frerl,�� <br /> i Othcr <br /> . CITY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br /> , I hereby ceritify that I have read and examined this application znd know the same to be true and correct. All provisicns of laws and <br /> ordinaces governing this rype of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> I ro give authority to violate or cancel the provision of any other state or local law regulating construction or the performancc of <br /> � construction.That I am authonzed by the owner of this property to perform the v:ork for which application is made and I comply with the <br /> i State Cont�actors Lav✓ 18.27 RCW and 296200 WAC. <br /> „� /7 r <br /> 1��Y.+G�C.�l�S1 �D' � � � '� <br /> iSignature o��wnedC ntr toqAuthonzed Agent Date <br /> i <br />