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PE� .MIT APPLICATIOh <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetiwa.org <br /> APPLICATIONS ARF ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# � <br /> �3�n/ Sr,� , �-/ �9� D Z�>% <br /> ILEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> � OWNER AOORESS CITY2IP PHONE <br /> f//[� S/ • //L/�2�%/hC2%s <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �.7�'� 13A�-2�2 � S,� - 3ii y <br /> CONTRACTtlR ADDRESS CIN21P PHONE <br /> C�2'72�/1evL :�? i-lz�� • ,9�c Z /�v /�i°c��.� �� �v `�-u lc i .25� -3//S/ <br /> CONTR.LICENSE t! <br /> �v�nG ss� ;�.z� <br /> USE OF BUILDING HEAT SOURCE CONTI'tACT PRICE OF WORK <br /> Electric Gas Other � ,5 �� <br /> !j/1�/.iC�i�77U.7rG_ c ��-/Gt_ — — — � ; O00 <br /> WORK DESCRIPTION <br /> �/1/`��_�c Ct /�!/ef-%7>./J /�/IC r.r9��D �//�j�% ` �/t C% <br /> y �ri��'C7fnu5� l/��� f��-`n5 G�43 I��/�/�UG <br /> PLUM8ING MECHANICAL I <br /> NO. NPE OF FIXTURE OR IT[M NO. TYPE OF FIXTl1RE OR ITEM <br /> "foilet A/C–air handling unils <br /> Bathtub / Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> , Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray P,ange hood <br /> �, _ Sink (service�bar/mopletc.) Exhaust fan I <br /> __ Backflow preventer Heat puTp <br /> Urin�l � Unit heater <br /> Orinking Fountain Boiler <br /> . Fioor drain Refrigeretion <br /> �, Grease lrap �Yoods�ove <br /> Roof drains Other <br /> Olher <br /> – —I I <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 � <br /> I heret�y ceritify that I have read and examined this applicatio::and know the same to be true and correct. All provisions of laws and i <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a permit Aoes not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or;he performance of <br /> constructilnrTfiat I am authorized by the owner ef this property to perform the work for which appiication is medE and I comply with the <br /> State GantrectoJ�Law 18�"7�2CW antl 295.200 WAC. <br /> ��'..f� /-�� � �v" �.. � s II <br /> Signature of OwnenContre nAuihonzed Agent �7ate I <br /> i <br /> � <br />