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( <br /> PERMIT APPLICATION <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 /> APPLIGATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �a� �-� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 25TFf S�, a -oa�-4 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER � r � ADDRESS CITY2IP PHONE �G�j��j' <br /> ��t�S �. t��c NS 2��7 25rN sT, �=�1�--�°�/,�llJ, z��� <br /> TENANT NAME � I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> WORK DESCRIPTION <br /> � � <br /> � <br /> /� G � �„�G�t 't ''�-�_ <br /> �PLUMBING MECHANICAL ii <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR�TEM I <br /> Toilet A/C—air handling units <br /> Bathlub Forced afr systems <br /> Lavatory(wash basin) Gas piping <br /> Shovrer Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasranya <br /> Clothes washer Clothe�dryer <br /> Walor heater Range hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> _ BackFlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinkinc,�'ountain Boller <br /> Floor drain Refr(geration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS 9105 <br /> I hereby ceriti(y that I have read and examined lhis application and know the same to be We and correct. All provisions oi laws and <br /> ordinaces goveming this type of work will bo complied with whelhar specified herein or not.The granling of a pertnit does not presume <br /> to give autnority to vioiate or cancel lhe provision of any other stale or local law regulatlng consWctlon or the pe�tortnance of <br /> con tion.That I am aut orized y lhe owner of this property to peAorm the work for which application is made and I comply wfth the <br /> te C ntractor .Law� 7,R and 296200 WAC. <br /> / / <br /> i ;i� ��� � � — � � <br /> �ig a ure of OwnedC n iactoNAuthorized Agent �'Date <br />