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F �RMIT APPLICATI�iN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8657—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADORESS PARCEI TAX I.D./ PERMIT A <br /> -i� - u �c��b�� <br /> LEGA LOTNO. BLOCK �'tACT <br /> DESC, - - '_`C- --!-. � <br /> ' WNER 1 ADDRESS CI"fV21P PHONE <br /> �'`- ---� <br /> q`d701 <br /> 14lILNAEL i ELI�AbE7H ���SA1 �CHuTT �QII QuC�EYLA�E c�r yZS 2S2 4M85 <br /> TENANT NAME � I CONTACT FOR PERMIT PNONE <br /> � � 9 <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE k <br /> USE OF 6UILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 5/- 2 E�ectric Gas Other � .1� � � <br /> W�RK DESCRIPTION <br /> ,,'�.vro��T � (�j�iAQAGr€ oN�y� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(7URE OR ITEM <br /> _ Toilet A/C-air hand�ing units <br /> _ Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower \Nater heater <br /> _ Kitchen sinM.&disposat Gas fireplace <br /> Dishwasher Gas range <br /> _ Clolhes washer Cloth@s dryer <br /> _ Laundry fray -----.. _ Range`�tood <br /> Sink(service/badmop/etc.)� � ��-� ., Exhaust(an�'• <br /> _ Backflow preventer � _ _ Heat pump � <br /> Urinal Unit heater <br /> Drinking Fountain aoiler <br /> _ Floordrain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE 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 laws and <br /> ordinaces governing this woric will be complied with whether specified herein or not.The granting of a pertnit does nat presume <br /> to give a i t or ca el the provision of any other state or local law regula6ng construcUon or the per(ortnance of <br /> const ion. at I a a oriz d by the owner of this property to perfortn the work for whfch application is made and I compty with the <br /> State ontr tors Lg 18.2 W and 296.200 WAC. <br /> � � <br /> Signatuie of Owner/Contr uthorized Agent ate <br />