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PE.ZMIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> �125-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �5 r � ���c::P a��vc-�-�v L �o- � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS CITY2IP PHONE <br /> 1-�r�-'! �K c-�-rz dz�z ,S� 5 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> CONTRACTOR ���jNsv� ����y��r AD�RESS CITYIZIP PHONE <br /> i9d3c.� iz,/n1 a��- �.� <br /> CONTR.LICENSE# �7g/,vCs� L�72[y ��c��-�-ri^�� 36o Va��K6` <br /> �i k1-2"� <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE C F WORK <br /> S�i� Electric Gas Other <br /> WORK DESCRIPTION <br /> /.c,Si/FcL ,-S. S->57Z�r /i.- n.c�� S;�Z <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUf�c OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&�isposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmopletc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> � SP�����crn_S <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 9105 <br /> I hereby ceritify that I have read and ezamined this application and know the same to be we and correct. All provisions of laws and <br /> i ordinaces governing lhis type of work will be complied wilh whether speciFied herein or not The granting o(a permit does not presume <br /> Ito give authonty�o violate or cancel the provision of any other state or local taw regulating construction or the performance of i <br /> conshuction.That I am authorized 6y the owner of this property to perform the work for which application is made and 1 comply�vith the �I <br /> i Slate Conhactors Law 18." RCW and 296.200 WAC. � <br /> i�I_I'�� s/��/> ,� <br /> Signature ot vnen ontractorlAuthonzed Agent Date �- <br />