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PE MIT Af�PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREIT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I <br /> SITE ADDRESS S���y �b PARCEL TAX I.D.�Y PERMIT# 1� <br /> � a-�, /�-� , �.�.. zSoS (� c� O (��b ��� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> (1WNER ADDRESB CITY2IP PHONE <br /> �.C'�. (3�X I 3 �(�4K11—tA VvA `�89 0 <br /> �OI�C S'C.t ti'C �I M , ,., r <br /> TENANT NAME ! CONTACT FOR PERMIT PHONE <br /> QU�l1Ht�M P�T�ICI� J I �'�v�-�1 C�n ( `-�-Z� - `�-�-o-�S �- . <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eiectric ,x Gas_Olher I O �Q� <br /> I WORK DESCRIPTION <br /> I NST��I, • Tk(� Z �-I oGf7 � �7� k 3 ' � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> Toilef A/C—air handling units <br /> _ Bathlub 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 washar Clothes dryer <br /> Water heater � Range hood <br /> _ SinY,(service/bar/mop/etc.) � Exhaustfan <br /> Backflow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olhar <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and correcL Atl provisions of laws and <br /> ordinaces governing this type o(work will be complied wilh whelher specified herein or not.The granting of a pertnit does not presume <br /> to give aulhority lo vioiale or cancel lhe provision of ary other slale or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform ihe work for wh(ch application is made and I wmply with the <br /> State Coi trecto s Law 1827 RCW and 296.200 WAC. <br /> �`�Signatur O n 1C tr cl d th r nt Date <br /> r <br />