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PLr�MIT APPLICATIG:� <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 ADDRES-S�- _� �}- PARCEL TAX I.D.p PE MIT <br /> y 320 I �f'i 4te �(' -�u-i�'1 I �b -.� �-- <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �'�.,K S , I��G-o �,,, �- �ti1-, 9�� C4�z.s�g syL <br /> TENANT NAME I CONTACT FOR PERMIT PNONE <br /> CONTRACTOR � ADDRE S CITY2IP PHONE <br /> ��,, , � „�k � <br /> �t m�� c���� o��ti� <br /> CONTR.LICENSEk G u �m b�,� �s -SuSA�1��� <br /> I <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �a y�.� _Eiectric �Gas_Other <br /> WORK�ESCRIPTION <br /> T�s��t �s �o, �� n � x�s�r;rq �F��plQce <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 Forcedairsystems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> __ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boller <br /> _ Floor drain Refigeration <br /> _ Grease trap Woodstove <br /> _ Roofdrains ,� Other rcw i$Ti� <br /> _ Other _ ¢lKpt�e <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of Iaws and <br /> ordinaces governinq this rype of work will be complied with�vhether specified herein or not.The grenting of a permit does not presume <br /> to give authority violate or cancel the provision of any other stat2 or local law reguladng construcUon or the parformance of <br /> constru on.T at am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> St te Contr c r La 18. 7 CW and 296.200 WAC. <br /> o � �0 -�3-�Y <br /> iSignat re f Owner/ ontracter/Authonzed Agent Date <br />