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P��tMIT APPLICATIOnI <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 -�EBIT 6 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADURESS PARCEL TAX I.D.11 P RMIT N <br /> �' t72 Q�c�v� Av . ���b�' � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> � I�e I t n L 5�e��y � 3�2 Q�cl�e; A�e c���I,iA 9Sszn1 `1tS-Z52-9za1 <br /> TEt1ANT NAME CONTACT FOR PERMIT PHONE <br /> I ��-� ��', � `I2s-so � -�jssG <br /> CONTRACTOR � ADDRESS CITY2IP PHONE <br /> �v,i ��n5�hc�.o../�i+�. 1 <br /> CONTR.LICENSEN ( I� W M51�.��jn f�,r{ ��eCt�l�� �2S'SJI'�155( <br /> 'JQ� ���i� 1�_ 1 OZ'"��I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �e S _ _Electric _Gas_Other I I 7 �1� � <br /> WORK DESCRIPTION <br /> � �,Pa�,�� ��o�:-,� , S�.�Y�����, ��.�t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%7URE OR ITEM <br /> _ Toilet A!C—air handling unils <br /> _ Bathtub F�rced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink&disposal Gas firepiace <br /> _ Dishwasher Gas range <br /> _ Clolhes washer Clothes dryer <br /> _ Laun�ry lray Range haod <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES 7A7(CODE IS 3705 <br /> 1 hereby ceritify that I have read and examined this application and know the same to be true ar�d correct. All provisions of laws and <br /> ordinaces governing this type of work will be compliod with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision oi any other statu or Iocai law regulating conshuctlon or the perfortnance of <br /> construction.That i am authorized by the owner of this property to perfortn the work for which applicatlon is made and I camply with the <br /> State Conlractors Law 18.27 RCW and 296.200 WAC. <br /> � �c�—.' '-f- G- O � <br /> Signat o wnedConlractor/ uthonzed Agent Date <br />