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PEr2MIT APPLICATIdi� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, 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&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS�a��'�Q� �✓ PARCEL TAX I.D.p PERMIT• <br /> 3 � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ����y� �.4,P��A Goy ���r�r! �d�n:' ���/ �.�cj <br /> 1ENANT HAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHOHE <br /> CONTR.LICENSE/ ��/"'��`� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �, �C Electric �Gas Other 2�� <br /> WORK DESCRIPTION <br /> RLPA�R �`CX W�'�./KE fO.Pi�/K� �PGAcElYJ��YT.� <br /> f�or�fB MAiA'T�iY.9�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> i oilet A/C–air hzndling units <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 /> Clothes 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 /> i = Floor drain = Refngeration <br /> Grease trep Woodstove <br /> � Roof drains Other <br /> � _ Other <br /> i CITY OF EVERETT LOCAL SALES 7AX CODE IS 9105 <br /> � I hereby ceritify ihat I have read and examined this applicaGon and know the same to ba true and cortect. All provisions of Iaws and <br /> Iordinaces governing this rype of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> I construction.That I am authonzed by the owner of this property to pertorm the work for which application is made and I comply with the <br /> Slate Contractors Law 1 .27 RCW and 296.200 WAC. <br /> '� A�� �t c-u✓ ,:..��... � �lo p�(� � <br /> � Signature of UwneriC ntractoU onzed Agent ate �L <br /> i <br />