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�. <br /> PE{�cMIT APPLICA�'10`iv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, 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 ADDRcSS PARCEL TAX I.D.# PFRMIT# <br /> ���i 41' - E "� t \ � Z <br /> LEGA L07N0. BLOCK TRACT � <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PNONE <br /> W114RI1JefL SL�c �� .T�i,��c�Trnc�` 'Ao f{Lz�c ins{'i ��/(_c�8c291 4 ?�{ +�niS�-' <br /> 7ENANTNAME I CONTACTFORPERMIT PHONE <br /> ..�V��UqI Yl 4 �I�A�� <br /> CONT}�AC?iTR `� ADDRESS CITY2IP PHONE <br /> N01�7ry wcS'i' �luw�in5 <br /> CONTR.LICENSE# <br /> NbRTN p�4SS1�1� ?S�]�'1 1(�G,-C� �( K�E �a:3 �rl�nt•h �'iSZ23 36� 6� ��y <br /> USE OF BUILDING I — HEAT SOURCE ' CONTRACT PRICE OF WORK <br /> ElecMc Gas Other <br /> WORK DESCRIPTION <br /> 1- S �1 I- 1-J4v l� o l� (- /-tt,.1_' <br /> PLUMBING MECHANIGAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C—air handling units <br /> Bathtub i"orced air systems <br /> � Lavatory (wash basin) Gas piping <br /> Shower Water heater <br /> �_ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Ciothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mo���etc:j Exhaust fan <br /> Backflow preventer _ Heat pump <br /> � _ Urinal Unit heater <br /> I � Drinking Fountain = Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> I _ Roof drains = Other <br /> Othuer <br /> I � .�1W�' -- — � <br /> ICITY OF EVERETi LOCAL SALES SAX CODE IS 3105 <br /> I <br /> iI hereby ceritify that I have read and examined this applicatlan and know the same to belrue and covect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with �uhether specified herein or not.The grantlng of a pertnit 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 authorized by the owner of ihis property to perform the work forwhich applicaGon is made and I comply with the <br /> ! State Co tractors Law 18.27 RCW and 296.200 WAC. <br /> � /��'l [� ��/�'l S �`�5`"p<� — <br /> Signature of Owner/Contractor/Authonzed Agent D�;e <br /> I -- <br />