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� P�rtMIT APPLICATI�i� <br /> CITY OF EVER�TT PERMIT SERVICES <br /> c�200 CEDAR STREET, EVE�ETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> � <br /> APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> IOZI� I� � �vr.. 5 ,� �ve,re�� ►'Vta5o1-D- a� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> I <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �-,��,. �� 3a,n� � �ZS-�32��0 � 4� <br /> CONTRACTO ADDRES ITY21P PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE CONTRAC;'pRICE OF WORK <br /> Electric �Gas Other I ����. o � <br /> WORK DESCRIPTION � <br /> --1_� ��'c< < oQ v �� S� S � �2� <br /> s�, 5 I�c� �2� � ���.. �� �.� 5� s��. f <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—airhandlingunits <br /> _ Bathtub � Fnrced air systems <br /> _ Lavatory(wash basin) Gas i in <br /> Shower — p P 9 <br /> — Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clathes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/ba;/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fuuntain Boiler <br /> _ Floor drain � Rafrigeratior, <br /> _ Grease irap Woodstove <br /> _ Roof drains Other <br /> = Other I = — <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> � I hereby ceriti(y that I have read and examined this applicat;on and know the same to be true and correct. All provislons of laws and <br /> ordinaces governing this type of•.vork will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authoriry to violate canc the p�ovision of any other state or local law regulatlng consVuction or the pertormance of <br /> construction. at I am horized y the �wner of this property to pertorm the work for which application is made and I comply with the <br /> State Contra rs La �8. nd 200 WAC. <br /> 1 /„/oJ^ �,y ` � <br /> Signatur of eri ntracior/ ut on ed Agent Oate� <br /> I <br />