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P�RMIT APPLICATit�t� <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 I <br /> SITE ADDRESS PARCEL TAX I.D.# PER � <br /> /s'�o y�sy S� // -D/� — <br /> LEGAL LOTNO. 6LnCK TRACT <br /> DESC. I <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> .�.G.�SJC� ���.D�l /os l�t/, rl,P.ce���'/�c��4. g���9 �Zo�oJ By9-sS90 <br /> TENANT N�A7h1E I CONTACT FOR PERMIT HONE <br /> iN�/�f <br /> CONTRACTOR O��_ AODRESS CITY2IP PHONE <br /> CONTR.LICENSE# � - <br /> I <br /> USE OF BUILDING �/ — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �yf/lvA�iV.d' /}� Electric Gas Other ,�7ep� - o0 <br /> / <br /> WORK DESCRIPTION � �_��f� �� �,� ��, , �/���� 5��,�5 ,P �C��*� I <br /> ya C/�6� �.✓ �.¢,P�:u�--- <br /> PLUMBING MECH,4NICAL <br /> INO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lav�tory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&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 /> BackOow Freventer Hezt pump <br /> Urinal Unit heater <br /> Drinking Fountaira Boiler <br /> Floor drain Refrigeration <br /> I = Grease trep = Woodstove <br /> Roof drains pther <br /> Other <br /> ' � <br /> ICITY OF EVEREiT LOCAL SALES TAX CODE IS 3105 � <br /> I hereby cerilify that i have read and examined this appiication and k.now the same to be tr��e and correct. All provisions of laws and I <br /> ordinaces governing this type of�.vork wiil be complied wilh whether specified herein or not. The granting of a permit does not presume i <br /> � to give authority to violate or cancel the provision of any other stale er local law regulating consWction or the performance of I <br /> construction. That I am authorized by the owner of this property to per.`orm the work for which application is made and I comply with the I <br /> i Stat ontractors Law 18.27 RCW a 296.200 WAC. <br /> r/LI ' o'�� � I/�� � �\ <br /> Sig�ature o OwnenC n[ractouAutho ed Agent '��rL�ate �/ <br /> Z � <br />