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PE�IMIT APPLICATIf��J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32U0 CEDAR STREET, EVERETT, WA 98201 ^ <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org /��p� -� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P �# <br /> �Sb 6 S�� �� Gl � � <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. � `�, ,�,� <br /> OWNER ADORESS CITY2IP PHONE yZt_ 238 <br /> ��Q f9r�G/'F,E/rLLC /' G� /�oX 9/a C�iNC-y 9fzJ� 8'2ay <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �� ,�-�a,, �Co- 91 y- /93� <br /> CONTRACTOR �( yU /"a�7� G=� «< ADDRESS CITY2IP PHONE <br /> yf :rc <br /> CONTR.LICENSE# � i <br /> P/���'/fC� �o / 2Ll� ��D�o�( �//U �L/N��� 3Lo-3��- `f6u`1 <br /> USE OF BUIL�ING i HEAT SOURCE I CONTRACT PRIGE OF WORK <br /> S',�,� �'�„� I _Electric ZC Gas_Other i g � ysv <br /> WORK D'c CRIPTION �/,E(,�J S'� F�� •�w`z-�� <br /> �� ��-, �4 -,� <br /> PLUMBING � MEGHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. I TYPE OF FIXTURE OR ITEM <br /> 3 Toilet A/C-air handling units <br /> = Bathtub I Forced air systems <br /> Lavatory(wash basin) 3� Gas piping <br /> �� Shower �_ Water heater <br /> i Kitchen sink 8 disposal Gas flreplace <br /> � Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> � 8ackflow preventer Heat pump <br /> I Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease�rep Woodstove <br /> i = Roofdrains _ Other <br /> Other <br /> I CIT';Of EVERETT LOCAL SALES TAX CODE IS 3705 <br /> � I hereby ceritify thsl I have read and examined this application and know the same to be true and correct. All provisinns of laws and <br /> I <br /> ordinaces governing this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> , to give authonty to viol2te or cancel the provision of any other slate or local law regulating consWction or the performance of <br /> construction.That I am authorized by the owner of this pruperty to periorm the work for which application is made and I comply with the <br /> � State trac� w 1827J� and 296.200 WAC. <br /> I � �i /�/Z�O S` /L <br /> Signature of Owne/C�Authonzed Agent at� <br />