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. � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERV�r,ES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—F'X 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM -DEBIT 6 CREDIT CARDS ARE NOT ACCEPTED <br /> SITF.ADDRESS � . PARCEL TAl(I.D.X P MIT N <br /> � � e �,w�r'l N%3. 9/o759'ic�--3. a -G�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. � ED . <br /> OVYNER ADDRE$$ CITY2IP PHONE <br /> ��rr tc�Mr�u�r�- �'.l�E, � rau�sT�r �t�"r 98�1 4�-�-9�/3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �V�� (,CX'l�'lU�f//�' l�l.£f� f��t� <br /> CONTRACTOR ORESS CITY/ZIP PHONE <br /> ��t�'� GU� 9&�8 42S-2�u3-l�/ <br /> CONTR.LICENSEN DL-i�.�-f/NG•,i1��'l�S <br /> /�vC�it�7V CN' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRIC�WORK <br /> C���`"'`"IS _Eledric _Gas_Other ���� � <br /> WORK DESCRIPTION � r� ��f� �.�c ��(,� �� T��r� <br /> C�}� /�f/O�D4� 7a �P/�T T� �1Co�' <br /> �i/�1�T. <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling�nits <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes�vasher Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/moplelc.) Exhaust fan <br /> Backfiow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fcuntain 9oiler <br /> Floor drain Re6igeration <br /> �rease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceriti(y that I have read and ezamined this appliation and know lhe same to be Irue and correcf. All provisions ot laws and <br /> ordinaces yoverning this type of work will be complied with whether specified herein or not.The granting of a pertnit dces not pre<ume <br /> to give authority to violate or cancel the provision of any other state or local law regulating co��strudion or the perfortnance of <br /> construdian t 1 a ut rized by the owner of this property to perform the work for which;pplication is made and I comply with the <br /> �Sfate"-C6 ec o L 8 7 RCW and 29E 200 WAC. <br /> ( 9 �_ <br /> Signatur of OwnedContractodAuihonzed Agent Date �/L <br /> �-- — — --- <br />