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P�rtMIT APPLICATIOi� <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 PARCEL TAX I.D.# PERMIT A� <br /> l 0 w�- w+or�. v���°j lD '/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> TD�M W�( �Z.00 �CN �k..' {��/NAMti Gi�y jL <br /> TENANT NAMc CONTACT FOR PERMIT PHONE <br /> �4�� 5��+� � s-���� n�o��� �Zs ���-s�5s- <br /> CONTRACTOR bGrry NCuN co �ORESS CITY2IP PHONE <br /> 7�fco H�..�.sa.. ao yt,4-, <br /> CONTR.LICENSERgL��yN�o7x.., �va.ff� w4 S8zo3 77L• SY3.r <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'�S�''�^"�� Electric Gas Other � � ]$' o0 <br /> WORK DESCRIPTION . � � <br /> / NSIQCG �l) ZKS ��hn.�j� N/G /�QNcL <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> ICilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Ciothes dryer <br /> Laundry tray Range hoad <br /> Sink(service/badmop/etcJ Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> ; Floor drain Refrigeratinn <br /> I _ Grease trap _ Woodstove <br /> F2oof drains Other <br /> Other <br /> � — <br /> � CITY OF EVERETT LOCAL SALES SAX CODE IS]103 <br /> I hereby ceritify that I have read and examined this applicatlon and know the same to be true and correct. All provisions of laws and <br /> , ordinaces governing this type of work will be complied wilh whe[her specified herein or not.The granting of a permit does not presume <br /> ' to give authonry to violate or cancel tna provision of any other state or local law regulating construction or the perfortnance of <br /> � construction. That I am authorized by the �mer of this property to peAortn the work for which application is made and I comply with[he <br /> ISlate Contractors Law .27 R i 0 WAC. <br /> � � <br /> ' Signawr�a�-e O�n ontracror�Authonzetl Agent Date p[� 1 <br /> L� <br />