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' � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4'L5-257-8810— 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 /> I SITE ADDRESS PARCEL TAX I.D.N I y�RMlj N_ �� <br /> i 9U5 �ev � �u�ret+ �(1� c^�/O /7p oo� �'o/-0-3 �c �rr�-� - <br /> ILEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> �CltQ'C�/Y�I,N����yS� �(�6 e�✓/ CITYlLIP PHON D / � <br /> /1�,�' ��;l(�4Q-�82zs�.? � �_ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> SPGview AFN <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE M <br /> USE OF BUILDING HE4T SOURCE CONTRACT PRICE OF WORK <br /> � � iT(� �O1Y1 !' ti�ctric _Gas_Other <br /> WORK UESCRIPTIO <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C—air handling units <br /> O Bathtub L Forced air systems <br /> � Lavatory(wash basin) Gas piping <br /> Shower _L Waterheater <br /> ! Kitchen sink 8 disposal Gas fireplace <br /> I Dishwasher Gasrange <br /> i Clothes washer � Clothes dryer <br /> _ Laundrytrey Rangehood <br /> Sink(service/bar/mopletc.) = Exhaust fan <br /> Backflow preventer � Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain L, Refrigeration <br /> Grease trap Woodstove !� <br /> I � Roofdrains I1O1i1e _Z OtherW[�_�IrPT_tpr �o�ver a�tn9� <br /> �(-_ Other QLl+1�fS Cl�� (.l�tYu`�� <br /> �- r � tU. In (�tIC(bNK1YG <br /> i CITY OF EVERETT LOCAL SALES 7AX CODE IS 1105 <br /> '� I hereby ceritify that I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> ! ordinaces governing this rype of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authonry to violate or cancel Ihe provision of any ot ier state or local law regulating consWction or the perfortnance of <br /> iconsiruction.That I am authorized by the owner of this property to perform lhe work for which application is made and I comply with the <br /> State Contractors RCW a d295.200 WAC. <br /> j — � .�: Or� O� <br /> _ =�� <br /> ISignature o Owner tracror/Authonzed Agen[ Date � <br />