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F��MI'T A�PLICATIG�J <br /> CITY OF Ei/ERETI" PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257•H857—www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS , PARCEL TAX I.D.N PERMIT N <br /> �`+31 ��1 x�,,,,�,� Ux. Pas�?-or�g' <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. y'� - L�7 – �S3 <br /> OWNER ADDRESS CITY2IP PHONE <br /> L-.ISG� 17v��cN� (��') 3) �c.�} Xcv,c�l�Uc, �— vert_�� �, IV2��J <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> :�s� C.�,�ice ��vti.���y,, I�I2(� ic�o S�SI.v ��<��� � �l2S-2��7 -�i33y <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE N ���\ I� � � ^ ^ �N <br /> ry -� 1 <br /> USE OF BUILDING ` HEAT SOURCE � CONTRACT PRICE OF WORK <br /> r�' <br /> �ectric _Gas_Other �(JV— ,}��� <br /> WORKDESCRIPTlOj1C `GWt �Ca�/�.� blv�c � v�. ` �v�C W/ N��✓ l ��`�� <br /> �Y � �L.�� eN/ �1 {SL ` � I InW.CC W� M��r I�'D <br /> �,,,,�� ��n5 N �L � V r V C c� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OP FIxTURE OR ITEM <br /> Toitet A/C–air handling unils <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Cbthes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmopletc.) 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 drai ` Other <br /> � oine� ��1�,, wc.`�«sc�� ,�L — <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and know lhe same to be true and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whelher specified herein or not.Tha grantlng af a pertnit does not presume <br /> to give aulhority to violate or cancel the provision of any olher stale or local law regulating conslruction or the perfortnance of <br /> construction.That I am aulh nze y tha owner of lhis property to perform the work for whfch application is made antl I comply with the <br /> Slale Con clors Law 182 RC nd 296200 WAC. <br /> � � � —�� <br /> Signature o wnedContractodA o zed Agenl Date <br />