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P�r2MIT APPLICATI�nI <br /> CITY OF EVERETT PERMIT SERVICES ; <br /> 3200 CEDAR STREET, EVERETT, WA 98201 i <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org i <br /> APPLICATIONS ARE AC�EPTED FROM 6 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI M � <br /> 0 3 'f S-n-! c. S� -�`' <br /> LEGA LOT NO. BLOCK TRACT � � <br /> DESC. <br /> OWNER ADDRESS CITY21 E � <br /> : �N�/�l/,�a� U�1NS7 I <br /> TENANTNAME I CONTACTFORPERMIT PHONE I, <br /> CONTRACTOR ADDRESS CRY21P PHONE <br /> /?.v,�gr,uScbv Iq-��G• 36d �7 �VG2 <br /> �aa� n�� -4+-� y��z� 3 << <br /> CONTR.UCENSE N /�_, /1�N P *Z J uL �� ����� <br /> /�'-v i7 <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> s � Electric Gas_Other 3C1UU <br /> WORKDESCRIPTION /N N�'�— CFsC <br /> �NS)/ic�� `!2P �p.e.e'n�/L4o'7�.5 • <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF Fp(TURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Fotced afr systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _, Gas flreplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry Vay _ Range hood <br /> Sink(servicelbaNmop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heatar <br /> Drinking Fountain _ Boiler <br /> Floor drain Refigeratlon <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> _ Other � <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3103 <br /> II h�reby ceri6fy that I have read and examined this applicatlon and know the same to be true and correcL All provisfons of laws and <br /> ordinaces goveming this type of work will be complied with whether spec'rfied herein ar not The grantlnp of a permit doea not presume <br /> to��ive authority to violate or cancel the provision of any other state or local law reguletlng consWction or the performance of <br /> construction.That I am authorized by the owner of this property to perForm the work for which applicadon is made and I comply with the <br /> State :.ontractors Law 18.27 F2CW and 296.200 WAC. <br /> F•.�`�•l��vl__l� 'S�J�fIUS� <br /> Signature o Owned ontractodAuthonzed gent at-6 e— �/L <br />