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PC�:RMIT APPLICATI� N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRES�// /� �� �,�. PARCEL TAX I.D.# PE�tMIT# <br /> 'Y �VI � �O � � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OnWNER / ADDRESS CITY2IP PHONE <br /> UZ��y,t� ,q�kS���dl� S�r �f� ,��'. s/_r _/-'��r��e/ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> C'a.,��ar,E �a�/� / �Q a/ � .l,la,r,'</� !✓�9 9�z S' <br /> CONTR.LICENSE# �'37 Db ' ����C �/� �� <br /> �v�,�o�/ yy2 My ' ,zs3y�. ��s� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �r�'� _Eleciric X Gas_Other ��Z�� BO <br /> WORK DESCRIPTION <br /> ���)(�c��P �� ��v, .�a � <br /> i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OP FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) (� Gas piping <br /> Shower �f Water heater <br /> _ Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> � Water heater _ Range hood <br /> Sink(service/bar/mop/elc.) _ Exhausl fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> = P Woodstu <br /> R ofdrains X Other fu!��''e <br /> Other <br /> CITY OF EVERETT LOCAL�ALES TA%CODE IS 9105 <br /> I hereby certify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this lype of work will be complied with whether specified herein or not.The granting of a pertnit does�ot presume <br /> to give authority to violate or cancel the provision of any other stale or local law regulating construction or the perfortnance of <br /> construction 7hat I am authorized by the owner of this propeRy to perform the work(or which application is made and I comply with the <br /> State Co, clors Law 18.27 RCW and 296200 WAC. <br /> . � �y/os/o <br /> Signature of Owner/Coniraclor/Authonzed Agenl '� <br />