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PE� rtMIT APPLICATI�i� <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.# �RMIT J) �` � <br /> 231a we%MaaE a�.�v <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PMONE <br /> J"o syu�cFNa�z� .z3la c.�-rr�a,eE Ev2�,- <br /> TENANT NAME I CONTACT FOR PERMIT PNONE <br /> CONTRACTOR ����dy na��U�/0� ADDRESS//,3�� d�0 � ! U, CITY2IP��SUL, PHONE <br /> C, 7 /V <br /> CONTR.LICENSE N ��A�yG d 7 �Q� - -�J�1�/ .3 Ga -652-s6e� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> s �' � <br /> � � 2 , K Electric Gas Olher 'Z 2 5Q <br /> WORK�ESCRIPTION <br /> Ta ihA�E ,�EP�9i2s 0� 6'Xi8 ' F2aNj ,�Q,ec,y� <br /> NEW Q�c�< Fk�aMi�x, /�uT ���r.�r5 Aa2� � �i.� P/�ccr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTVRE OR ITEM <br /> _ Toilet AIC—airhandlingunits <br /> _ Bathtub Forcedairsystems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> Ciothes washer Clolhes dryer <br /> _ Laundry tray Range hood <br /> Sink (service/barlmop/etc.) Exhausi fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeralion <br /> Grease trap Woodsrove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I <br /> II hereby ceritify that I have read and examined this applicalion and know the same to 6e lrue and correct. AII provisions of Iaws and <br /> ordinaces governing this type of work wili be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> ito give authonry to violate or cancel the provision of any other state or local law regulating consWctlon or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and t comply with the <br /> � State Contractors Law 1827 RCW and 2@6200 WAC. <br /> � l+,l�� l �� �3 ,a � � <br /> Signature of f�wner/Contra�tor/Authonzed Agent Date �� <br /> / <br />