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PE�ZMIT APPLICATIa�� � � <br /> CiTY OF EVERE�'T PERMIT S�RVICES ��o�� <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 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AC7DRESS �k�D� PARCEL TAX I.D.# � ERMIT# <br /> � t41� A� � � ��T�� ���� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �t.1�t�tr-� i�',F�.�,P,-{�t,r�- p.o. � lft�`l �t�.lAssy ��i'}I �ZS �4 �"J l <br /> TENANT NAME CONTACT FOR PERMIT PHONE ��5 <br /> �Il.��-1 Gkl�o�fL I �a�.rc�-� ��¢�-,C�rtz�c� �'�}IT�TS 3�� �L� <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> �(S(�"U�`3(� CA�P • <br /> CONTR.LICENSE# ����W G`Q�� <br /> !J <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��.V- Electric Gas Other ��Q ��_" <br /> WORK DESCRIPTION <br />' T�t��r(' (hnn0�a�h�wl�T <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PIXTURE 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 dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Greaee trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY�F EVEREiT LOCAL SALES SAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined this application and know the same to be true and correcf. All provisions of laws and <br /> I ordinaces goveming this type 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 consWction or the performance of <br /> icons ae' .� I authorized by the ovmer of this property to perform the work for which application is made and I comply wiih the <br /> Stat ntr c r L !1$.27 RCW and 296.200 WAC. ( <br /> � � � '���� �� <br /> I Signature of Owner/ContractovAuthorized Agent Date <br /> ' l <br />