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� - <br /> 5 � � <br /> � -I <br />� ad{.;;: <br />� '.,, '� . �ERM�T APPLICAI ,ON <br />�'` ; ';�' � C�TY OF EVERETT PERMIT SEZVICES <br /> b �y� 3�00 CEDAR STREET, EVERETf, WA 98201 <br />� � � 425-�b7-8810— FAX 425-257-8857—www.everettwa.org <br /> 4����''-r I APPUCATIONS ARE ACCEPT�D FROM 8 kM TO 4 PM - DEBIT& CREDIT CARDS ARE NUT ACCEPTED <br /> I �Y <br />� � "� SITE ADDRESS PARCEL TAX I.D.# PE�MIT# /' <br />� ; '; I 7 UC� S� _�� ��,.. , � ; <br /> � LEGAL LOTNO.� BLOCK TRACT <br /> DESC. <br /> a <br /> • OWNER AL'DRESS CITY2IP PHONE <br />�,; ; _h �� �� <br />�.i �;�.,- � <br /> s�:;r.;��� �+ <br /> f�r::E,,;;� r� — <br />.. ,. TENhNT NAME I CONiACT FOR PERMIT PHONE <br />;�.',� ... ':� � I <br /> t � �� � CONIRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTf:.LICENSE k � � , <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WOR{< <br /> Si <br /> ��L-- Electric Gas Other � <br /> � <br /> WORK DESCRIPTION <br /> � � <br /> � �f�t.t�'1c.,(l��O�—�C U�� �� <br /> �» PLUMBING MECHANICAL � <br /> • �� NO. TYPE OF FIXTURE OR I7EM NO. TVPE OF FIXTURE OR ITEM � � <br /> _ Toilet _ A/C–air handling units � I <br /> __ Balhtub 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 r <br /> _ Laundry tray Range hood � <br /> Sink(service/badmop/etc.) Exhaust fan <br /> _ Backilow preventer Heat pump <br /> Urinal Urit heater �` <br /> Drinking Fountain Boiler ' <br /> _ Floordrain Refri,eration <br /> I� <br /> Grease trap Woodstove <br /> Roof drains Other <br /> i _ Other = <br /> � <br /> CITY OF EVERETf LOCAL SALES SAX CODE IS 9105 <br /> I hereby cerilify that I have read and examined this application and know the same to be We and correct. All provisions of laws and ' � <br /> ordinaces goveming this type of work will be complied wilh whelher specified herein or not.The granting of a permit does not presume f'; <br /> to give aulhonry to violate or cancel the provision of any other stale or local law regulating conslruction or the per(ormance of <br /> conslruction.That I am authorized by the owner of lhis property lo perform lhe work for which application is made and I comply with thr, �, <br /> State Conlraclors Law 18.27 RCW and 296.200 WAC. u, <br /> I- <br /> Signaturo of Owner/ConlractodAuthorized Agent Date f <br /> Y � � <br /> � <br /> — - - _ � <br />