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: <br /> P RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE'i, 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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS /� /G PARCEL TAX I.D.N PERMIT/ <br /> Z�Z� /\U�yG /r .5�� �7`I <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE35 CITY2IP PHONE <br /> J�� �i/��I�YJ j''� Z.�l.� /C llL,��r Jl G�''' ypy� Z S��Os�'J <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR ,,/• L //�,J��� �L� (, , qpDRE�I I.ST Sy- � /' <br /> Vfi iX'G'I // � � CITY2IP PHONE <br /> CONTR.UCENSE R�,O,� I�� ^����� � " / J tid�ie�ir�( y�s � ����, <br /> !sR y « <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � 1 � _Electric Y Gas Other �+ z S � <br /> WORK DESCRIPTION (� <br /> ��5�1� /1/eL-✓ V�S �PnAcf <br /> PLUMBING MEC�IANICAL <br /> NO. TYpE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C–airhandlingunits <br /> _ Balhtub � Forced air systems <br /> _ Lavatory(wash basin) <br /> � Gas piping <br /> _ Shower Waterheater <br /> _ Kitchen sink&disposal Gas fireplace <br /> Dishwasher — <br /> Clothes washer _. Gas range <br /> — Clothes dryer <br /> _ Laundrytrey Rangehood <br /> _ Sink(service/badmop/etc.) Exhaustfan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiier <br /> _ Floor drain Refrigeration <br /> _ Grease Irap Woodstove <br /> _ Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS J103 <br /> I hereby ceritify that I have read and examined tliis application and know the same to be true and correct. �II provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.Tha granting of a permit does not presume <br /> ro give authority to violate or cancel the provision of any other state or local Iaw regulating conshuctlon or the perfortnance of <br /> constructio t I am authorized by lhe owner of this property to perfortn the work for whicn application is made and I compiy with the <br /> State C trect s Law/18. RCW and 296.200 WAC. <br /> �/G� �/� ' % 0 <br /> Signat of V nedCcniractor/Authonzed Agent Date <br />