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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-8810— FAX 425-257-8857—www.everettwa.org /�� �� ` �� <br /> Y <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> � <br /> SITE ADDRESS _� PARCEL TAX I.D.# PERMIT# � <br /> `fs3� �a Sf o�°/�o�� � � 6 0� � OSa'/�o <br /> LEGA LOT NO. BLOCK TR 7 <br /> DESC. � � r�,�� <br /> QWNER ADDRESS CITY21? PHONE <br /> /��D /�an-(� L� ����t 9/0 �� r ��3� 2 <br /> G�.�'� G�- �- y �T�� z�y <br /> TENANTNAME � CONTACTFORPERMIT PHONE <br /> �`'EC � • ; ��l<���.� � ` yZs���- �2Z�� . <br /> CON�tACTOR ADDRESS CITY2IP PHONE <br /> /(�D !`'o-r�Gr�.�.�Lc , . � . . <br /> CONTg�LICENSE# �J / � � ��'�'� ' <br /> /�/1/C�"CL %� oiz<G' / /U ��/T /��U �� 1�23C ••�2S Z3fJ��25� <br /> USE OF BUILCING � HEAT SOURCE � CONTRACT PRICE OF WORK <br /> �j f'�n ���/� _Electric �Gas_Other yr�U� <br /> WORK ESCRIPTION <br /> /�� � -�.� <br /> .J+,.-./ /�G->..,._( C./� C..-Z <br /> PLUMBIN MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PU(TURE OR ITEM I� <br /> � Toilet A/C—air handling units <br /> y� Bathtub % Forced air systems I <br /> t�3 Lavatory(wash basin) � Gas piping <br /> � Shower Waler heater <br /> / Kitchen sinh 8 disposal Gas fireplaco <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> _ Laundry tray 1� Range hood <br /> Sink(service/badmo;,/etc.) 6[ Exhaust fan <br /> � Backflow preventer 7 Heat pump , <br /> _ Urinal Unit heater I <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVER'cTT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing !his type of work will be complied wilh whether specified herein or not.The granting of a parmit does not presume <br /> to give aulhonty to violate or cancel the provision of any other state or local law regulating constructlon or the performance of <br /> I conslruction. That I am authorized by lhe owner of this property to perform the work for which application is made and I comply with the <br /> State Cunlr ors Law 1 .27 RC an 296.200 WAC. <br /> ����� i� 7—8`�S <br /> Signature of Owned ontracror/Authonzed Agent Date ��L <br />