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P��ZMIT APPLICATI��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& CREDIT CARDS ARE NOT ACCEPTED <br /> SI7E ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 7��3o vP.�q2 �,����= 2,� /� �i� - 00/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> nWNER ADDRESS CITY2IP PHONE <br /> /Q �/�Q �!✓�J2 P/Z (S C�S <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> � <br /> CONTRACTOR ���N�.�N �m` AOORESS CITY2IP PHONE <br /> L933o /2Yi-ii A.c-' ,36od Y3s�� 9 <br /> CONTR.LICENSE fl „� ��,�,P ,� z 7zc L ^�� '��'"�'�" � <br /> 4�1z � <br /> USE OF BUILDING I — HEAT SOURCE I � CONTRACT PRICE OF WURK <br /> S � ti� Electric Gas Other <br /> WORK�ESCRIPTION <br /> /NS i�CC F. S SYSicT-"»� /N .�C 7�. S��2 <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C–airhandlingunits <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> _ Clothes washer Clolhes dryer <br /> _ Laundry tray Range hood <br /> Sink (service/badmop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Unnal Unit heater <br /> Orinking Fountain Boil3r <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> — 1� SPRin�rc[–,�LS <br /> CITY OF EVERETT LOCAI SALES 7AX COOE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of lae�s and <br /> ordinaces governing this type of work will be complied with whether specified herein or noL The grantin�of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am aulhorized by the owner of lhis property to perform the work tor which application is made and I comply with the <br /> State Contrectors Law�27 R nd 296.200 WAC. <br /> "'� `k ( �I�� (7�(4� <br /> Signature of OwnenContractorlAuthonzed Agent Date �'v <br />