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f <br /> P�r�MIT APPLICATIG�J <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—w:vw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBI7& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# RMIT# <br /> b5 0 �`l +� - <br /> /fvc SG� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADURESS CITY2IP PHONE <br /> ��� ��c l�r 37�f IoB�R 5fi ,5� �v��..F-F <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> C.}Sca�P� I�lQzA S�c �c PLo,,. l, �fzs- 776-8'�C3S� <br /> CONTRACTOR �� r ry /t/t�,� c u �DRESS CITY2IP PHONE <br /> / �y�� n �„�.-.�+J � yzs- 776-$83s-. <br /> CONTR.LICENSE il �J¢r.�i3 u,� Rs.t' <br /> /3G�r�rN c o7]�n, <br /> � I _ _ __ <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other ,� �9� g 9�. o� <br /> WORK DESCRIPTION • <br /> /AJS���L C�� �OLL sISN <br /> PLUMBING MECHANICAL <br /> N0. � 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 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dry9r <br /> _ Laundry trey Range hood <br /> Sink(service/badmop/etc.) E�chaust fan <br /> Backflow 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 /> ICITY OF EVERETT LOCAL SALES 7AX CO�E IS 3105 <br /> I hereby ceriti(y that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> I ordinaces governing this rype of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am aut rized by t er of is-property to perform the wort:for which application is made and I comply with the <br /> State Contractors Law 27 RC C. <br /> Signatur Owner Contractor/Authonzed Agent Date <br />