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P�RMIT APPLICATI� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE7T, WA 9$201 <br /> 425-257-5810— FAX 425-257-8857—www.everettwa.org 6 � �.O�0 5 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T�4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADD ESS � PARCEL TAX I.D.# PERMIT# <br /> /C��� i�1 '-� s� 1�0�'E� <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNE ADORESS CITY2IP PHONE <br /> ��"v�i� 7��4-n� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> SCv��2C�?e� ,�vl�"r�L <br /> CONTRACTOR � AD E CI PHONE <br /> 6u�R�/�l5onl .r��+�4�«QO ��}�3/ ��e,��en. ,�-G���`" ��7 � <br /> CONTR.�ICEN S� !8'2 DR 8'ZZ3 <br /> _�� <br /> USE OF BUILDING HEAT SOURCE CONTRAGT PRICE OF WORK <br /> �.t�QJ���k� _Electric _Gas_Other � <br /> WORK DESCRIPTION . � � � <br /> rl�Gu c�wt �vVleDcc�� R�l.L� Af� Lr�r�.e� isv (o �C�ts <br /> PLUMf31NG MECHANICAL <br /> NQ. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas firepiace <br /> Dishwasher Gas range <br /> Cbthes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servi�e/badmop/etc.) Exhaust fan ' <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> � _ Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease Vap _ Woodstove <br /> � Roof drains � /1��/_,: , Other <br /> I J� Other� r�� R.0 %��(/uG. _ <br /> CITY OF EVERETT LOCAL'..ALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicatlon and knew the same to be true and corcect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whethe�specified herein or not.The grantlng of a permit does not presume <br /> to give authonty to vlolate or cancel the provisior.of any other state or local law regulaling construction or the performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Cont ctors Law 1 7 RCW and 296.200 WAC. <br /> �� ���A. ���1//'iL�%/IiQ�t�l't 1 —�� � S <br /> Signature of Owner/Contractor/Authorized Agent Date <br />