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P��RMIT APPLICATII�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, W.4 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO A PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br />, SITE ADDRESS PAkCEL TAX I.D.# PERMIT# <br /> 2�a�_:._: z�, `` �1. a�yo1(�`i��ol`io� �-au <br />� LEGAL LO'i NO. BLOCK TRACT <br /> C�SC. <br /> OWNER ADDRESS CITV2IP PHO�y� <br /> �i r I ; �r..r s-1 �, �.� �C;�) Z�� Tv, J-�- L'tf���f;��� I��1 4 256" �7�`�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> .J� - +:�t ,��r ...� -��;`, I �i r�=;=s�', '.r r�r�.a--F-�; cl z s- 7_�-F1' ��15$ <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE'JF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> i:- Electric�k Gas Olher <br /> 1 ���, ,; 1�� ���;�iv�:-•-�1"' — — <br /> WORK DESCRIPTION <br /> c� �� � � <br /> l�� . � , .:.�1(' (�( 1 ���t�-��, �-. 1 i' -� G <br /> PLUMBING `' MECHANICAL <br /> NO. TYP�OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balhlub Forced air systems <br /> Lavatory(wash basin) 1 Gas pipinc� <br /> Shower Water heater <br /> Kitchen,ink&oisposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Backflow preventcr Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiier <br /> Floo�drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> I Olher__-. , ! 1 �A ; — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 7105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governiny lhis type of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give authorify to violale or cancel�he provision of any other state or iocal law regulating construction or the performance of <br /> construr,tion.That�am authorized by lhe owner of lhis property to perform the work for which application is made and I wmply with the <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> _ , � 1 '� 5(,- � �u � .. <br /> Signature of J e%on ractor/Authorized Agent � Date <br />� <br />