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i <br /> ; P'`RMIT APPLICATI(,�V <br /> ' CITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREtT, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS �,� PARCEL TAX I.D.# PERMIT# <br /> 0 4d� / �— �e � ��Qs �c � o�9cb f.�a'os'.zc�cr�;� s'co .DU4 -dUG <br /> LEGA LOT N0. BLOCK TRACT I <br /> DESC. <br /> OWNEF2 AD�RESS CITY/ZIP PHONE <br /> �;!l,� h�„�t� 33�- �yo� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> GtiFF� !%�, =� I 33�- .zii�� <br /> CONTRACTOR ADDReSS CITY2IP PHONE <br /> CONTR.LICENSE# 6 � �FNCIioy,t�� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT FRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION <br /> j��,.,� �l��u. � � G�,,,:,�. <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A1C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen s�nh&disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> _ 8ackflow preventer Heat pump <br /> , Urinal Unit heater <br /> � Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this rype of work will be complied with whether specified herein or not.The granting of a permit does not presume I <br /> , to give authoriry to violate or cancel the provision of any other state or local law regulating consWction or the performance of <br /> � construction.That I am authorized by the owner of this oroperty to pertorm ihe work for which application is made and I comply with the ! <br /> I Sta Contrac!ors L 1 .27 C j a d 296.200 WAC. j <br /> i � . � -� - � ', <br /> ISjgna,ure of „Wner/Con a o� �t�pz d Agent Date <br /> l% <br /> � <br />