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PtRMIT APPLICATIGN <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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> �� P r7 Vy�� �`�6R� �ql>E _ I DasoS-o� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE AqS-..g7d '� �z <br /> �►am� �> �oyG� � O�.l' OX ss��� F vt,2s�`i' C�iU Q�o'd6 � <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ISArn�� 13 G��C� <br /> CONTRACTOR ADDRESS / CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE ONTRACT PRICE OF WORK <br /> . o-E�J <br /> �S , �� n�'(fi � �Electric _Gas_Olher � �Q <br /> WORK DESCRIPTION <br /> (��pI.ACF 3 �os-F �n�� �3�rah� (a� D � t-���T Ant7 �F A� � <br /> C�LnC�F-� {"1Gu.� F . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 7YPE OF FI%TURE OR ITEM <br /> _ Toilet A/C-airhandlingunits <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> Clo�hes washer Clolhes dryer <br /> _ Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> _ Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ F�oor drain Reirigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — — <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS�105 <br /> I hereby cerilify that I have read and examined this applicalion and know the same to be true and cortect. All provisions of laws and <br /> ordinaces governing this type of w�rk will be cumplied with whether specified herein or not.The granling of a pertnit does nol presume <br /> to give ontqio�violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> cons ction.That 1 am aul erized he owner of this property to perform the work for which application is made and I comply with lhe <br /> Stat Contractors Law 18 f nd 296.200 WAC. <br /> �.�" � s /3 .ns- <br /> nature of Owner/Con racto Au o 'zed Agent Date <br />