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� PERMIT APPLICATIO�v <br /> CITY OF EVERETT PERMIT SERVICES �� <br /> ' 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 A►A TO 4 PM - pEBIT 8 CREDIT CAROS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# p ��T g <br /> ll � � o �10�13 <br /> LEGA LOTNO. BLOCK TRACT - <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE --' <br /> bv�s�DcH P.o. 6a�. c�S1 �'rl��� c�/� 4?�3?� �[$ <br /> TENANT NAME CON7ACT FOR PERMIT PHONE���p,,,, <br /> s�"(�l��o�! f�D-�-��''1'3?Zr�ltb�'. 4gr�fl�P.� � �(2,W�t3 �V� <br /> CONTRqCTOR ADDRESS <br /> ��6,�-i. �. �O �x � CITY2IP PHONE <br /> CONTR.UCENSE# ' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �v� I _Elect-ic _Gas_Other I 2o��Q <br /> WORK DESCRIPTION <br /> �• � • <br /> PLUMBING MECHANICAL <br /> NO• IYPE OP FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C–air handlfng units <br /> �� Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> �. Shower Water heater <br /> � fGtchen sink&disposal �as fireplace <br /> ,_ Dishwasher 'as renge <br /> _ `C�lothes washer C es dryer <br /> Laandry traY —'� <br /> _ Sink�(�ervice/oar/mop/etc.) Exhau fan <br /> _ Backflo\v preventer Heat pu <br /> _ Urinal � Unit heate <br /> _ Drinking Fo�R in Boiler <br /> _ Floor drain Refigeration <br /> _ Grease trap — W���OVe <br /> _ Roof drains Other <br /> Other — — <br /> ' CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritlfy that I have read and examined this application and know the same to betrue and correct. All provisions af laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not The g2n6ng of a pertnit does not presume <br /> to give thority to violate or cance�the provision of any other state or Iocai Iaw reguladng constructlon or the performance of <br /> cons cti , t a uthorized by the owner of this property to periortn the work for which appilcadon is made and I comply with ihe <br /> Slate Va o . 7 R d 296.200 WAC. <br /> o � (� '� , � <br /> Signatu wner ConVacrodAuthonzed Agent Date � <br /> L <br />