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P�M�,T APPLICATI�I � g i <br /> CITY OF EVERETT PERMIT SERVICES ; <br /> i 3200 CEDAR ST�,E�T, EVERETT, WA 982�1 � <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 i <br /> SITE ADDRESS p y� PARCEL TAX I.D.# PF7RMIT# I <br /> ���-! ���� � 'V� lV� J J,�! �' - -- <br /> LEGA LOTNO. BLOCK 7RACT <br /> DESC. <br /> O'NNER AODRESS CITYfZIP PHONE I <br /> r>u�ar�9�µ i���c�-�"C }?o. Bcx lo� SKa�tortt�+ 9g2�1 �425•3�•�i8 I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> SusEi 1 121r�6 I�--�`1fl�A AIi�2 �CDl'ri7�v bc�GH'[�5 ��il"I�l� <br /> CONTRACTOR ADDRESS CITY2IP PHONE I <br /> PuC�r W�s'r GoC�E'. P•o. R�ac eS� D�(.�Nb-t�.l �2z3 � <br /> CONTR.LICENSE# <br /> pv6CfWG 167,`c6 , <br /> USE OF BUILDItJG I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ���� ��'��`� ElecMc Gas Other ���� / <br /> WORK DESCRIPTIC�N <br /> �� <br /> PLUMBING MECHANICAL I <br /> NO. I TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling unils <br /> _ Bathtub � Forced air syslems I <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water healer I <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range ' <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> _ 9ackflow preventer Heat pump <br /> Urinal Unit heater <br /> Orinking Fountain Boiler <br /> Fioor drain Refrigeration <br /> Crease trap Woodstove <br /> Roof drains Olher i <br /> Other ! <br /> — � <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9'I05 I <br /> I <br /> ! hereby cerilify that I have read znd examined this application and know the same to be We and correct. All provisions of laws and I <br /> ordinaces governing this type of work wili be complied with whether specifiea herein or not.The granting of a permit does not presume ! <br /> to give authonry to violate or cancel the provision of any olher stale or local law regulating wnstruction or the peAormance of ; <br /> construc;ion.That I am auth zed by the owner of this property to perform the work for which application is made and I comply with the � <br /> Slate CoNrec;ors�y ..� nd 296200 WAC. I <br /> �����'���_ � ' <br /> Signature or Owne c orlAuthonzed Agent Date /' \ <br /> �I � <br />