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P�RMIT APPLICATIOnI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX. 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPfED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PER IT N <br /> '�a o� � - -, %C�i -��D <br /> LEGA LOTNO. BLOCK TRACT <br /> �ESC. <br /> OWNER ADDRE33 CITY2IP PHONE �Iaj' �7"� �' <br /> r1��' '�f U �C1C� �-1�� I ��1'� � `'�,l,c.� L �v1Y� �l� u�s+`?�03� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �.bnr� �'�101��no�� �hr-�r , r'�1�-1� rut �I��-.3s� - i5 ?L <br /> CONTRACTOR AOORE9S CITYf'IP PHONE <br /> CONTR.LICEN9E N <br /> USE OF BUILDIN6 I � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ElecMc Gae Qther I <br /> WORK DESCRIPTION <br /> A��1-� ��, � � y ��. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUNE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Tailet A/C—eir hendling units <br /> _ Belhfub Forced alr systems <br /> _ Lavalory(wash basin) Ges piping <br /> Shower Waler heater <br /> _ Kitchen sink 8 disposel Gas flreplace <br /> _ Dienwasher � Gae range <br /> _ Clothes washer �Inthes dryer <br /> _ Laundry trey Renge hood <br /> Sink�service/berlmop/etc.) Exhaust fan <br /> ' _ Backflow preveniei Heat pump <br /> � _ Unnal Unit heater <br /> I = Drinking Fountain = Boller <br /> Floor drain Refrigeretlon <br /> _ Grease trap Woodatove <br /> =I Roof dreins = Other_ <br /> Other <br /> CITY OF EVERETT LOCAL 9ALES TN(CODE 19 7103 <br /> I hereby ceritity that I have read and examined this applicelion and know the same to be Irue and coned. All proviaions af lewe end <br /> ordinaces goveming this type ot work will be complied with whether specified herein or not. The granling of e permit doee not preaume <br /> lo give auihonty to violate or cancel the provision of any olher state or local law regulating construcUon or the pe�formence of <br /> consVu .an. 7hat I am authcrized by the owne�ot this pmperty to perform the work for which appficaHon ie mede and I cofnply wilh the <br /> State 9rrtr ctor; w 1B 27 RCW anJ 296.Z00 WAC. <br /> i� � <br /> ; ' � �" l�-DS <br /> Signat e o wner� ontractor�tFunze gent ate i L <br />