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� <br /> PE,�MIT APPLiCATlO�� <br /> CITY OF EVERET i PERMIT SERViCES <br /> 3200 CEDAR STREET, EVEf2ETT, WA 98207 <br /> 425-257-8810— FAX 425-257-8857—w,vw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AODRESS PARCEL TAX I.D.q PERMIT# <br /> I ��lr� -O/�I <br /> L�GHT LOTNO� BLOCK 1'kACT � � <br /> DESC.� I <br /> OWNER -�� ADDRESS CITY2IP PHONE <br /> /I�;�u/� � I/��,Q �c� � �9ry ��r`��� Sw,�A r veretf w� 9�'ZO�1 <br /> TENANT N E I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING — HEA'f SOURCF. I CON7RACT PRICE OF WORK <br /> _Electdc �Ges Other <br /> WORK DESCRIP710N <br /> � r�u� � �u� na�t�.��a/ ����s �o �e rQ ��. <br /> PLUMBING MEC�IANICAL <br /> NO TYPE OF FIXTURE OR IiEM NO. TYpE OF FI%TURE:iR ITEM <br /> _ Toilet _ A/C–eir handling unils <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basih) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal C,as flreplace <br /> ^ Dishwasher � Gas renge <br /> � Clothes washer Clothes dryer <br /> I _ Laundry tray _ Rar,ge hood <br /> Sink(service/b�Umop/etc.) Exhaust fan <br /> I _ Backflow preventer Heat pump <br /> � Unnal Unil heater <br /> j Drinking Fountain Boiler <br /> Floor drein Refrigeration <br /> � Grease trep Woodstove <br /> Roo(dralns Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS J1q5 <br /> �' I herehy ceriti(y that� have read and examined this applicati�n and know the same to be tue and correct. All provlsiona of lawa and <br /> I, orainaces goveming this lype o(work will be compliad wit�whether specified herein or nr:. The grantlng of a permil doea not preaume <br /> to give authonty ro violate or cancel the provision of arry cthe�state or local law regulaGn�constructlon or the performance of <br />� construction. That I am authonzed by the owner of this property to pedomi lhe work for which apyication is made and I comply wlth thA <br /> State Conlractors LaJw 18.27 RCW and 296.200 WAC. <br /> r` />I/ �4.� -� V "r� L <br /> I Signature o wnnn nirac;onAuthonzed Agent ate <br />