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P��tMIT APPLICATI�i�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEkETT, WA 98201 <br /> 425-25i-8810-FAX 425-257-8857-www.e�erethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AOD ESS PARCEL TAX I.D.# P RMIT <br /> � 3 �k�r �vc� ��j/ - oe 3 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONE <br /> �'ucr�2� � ti��cl� o-� C'h �,Sfi A'��l (�vcK��' �iaS�9���03 <br /> TENANT NAME CONTACT FOR PERMIT pHONE <br /> N"'�'3�O-65��yaia-PQx <br /> 1��' (�N'�ow � �iya�=5�-aa&�9 <br /> CONTRAC70R ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> G'� U� _ElecMc _Gas l!Other I <br /> WORK DESCRIPTION ��J � �� • <br /> ��.�a.v.'�-I�r� c�. /L�'s /�"`',"`=� — y1,P�J �u�'� �3 .�od��.y <br /> � J <br /> i4'�f+ ��»", �iar�� �`x r�o�S <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FbCTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet AIC—airhandlingunils <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 /> Ciothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> � Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> I _ Other _ _ <br /> I — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> crdinaces governing this type of work will be complied with whether specified horein or not.The granting of a permit does not presume <br /> to give authonry to violate or cancel the provision of any other state or local law regulating construcUon or the perfortnance of <br /> construction.That I am authorized by the owner of this property to per(orm the work for which applicaUon is made and I comply with the <br /> I State Contracrors Law 1827 RCW and 296.200 WAC. <br /> .d�l� 9��"` il— 9 -�o� <br /> iSigna r o( wnedContractonAuthonzed Agent Date <br />