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PE.ZMIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.If P M Ti1 <br /> cv I y W I�RR� � i �;o�r7o ��- 3+0 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. [�- C.� 13 �ZUc(.c�R t�IR�K l�OD <br /> OWNER ADDRESS CITY2IP PHONE <br /> po� �ar��c c� ��( w►a�-�� �u��r zs2 - �z .s� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR QU��rtf ����Z ADDRESS -3�Z7 ���� CITY2IP PHONE <br /> ` � �U�ev�:C� q2r-ZS�(-7Z5Z, <br /> CONTR.LICENSE X ������y�SC7 FK�- �� 3d� ab- <br /> USE OF BU�LDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> CsV�6t� Electric Gas Other <br /> WORK DESCRIPTION <br /> co��lsT'P-ckCc1� U-�x�r� �FR14U.« zu`}cZ�-1` !hL �2(�U1v� yN�q o�(=- � C� <br /> 4 �c{ wVa�z1+-r��J �T_ C�u.�c�.t� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FUCTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A1C–air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas flreplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry trey Range hood <br /> Sink(service/bar/mop/etc.) E�aust fan <br /> Backflow preventer Heet pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refigerallon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> � CITY OF EVERETT LOCAL SALES 7AX CODE 19 9105 <br /> i I hereby ceritify that� have read and examined this 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 specifled herein or net.The grenting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law reguladng constructlon or the perfortnance of <br /> �� construction.That I am authonzed by the owner of this property to perform the work for which application is made and I comply with the <br /> � Slate-Gontractor/s La�w 18.27 RC and 296200 WAC. <br /> � �� ( / ///� �----- / - 3 � �0 5 <br /> Signa ut r�of Owneri ontrectoriAuthonzed Agent Date � <br /> L <br />