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FcRMIT ARpLICATIuN <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I,D. p PERMIT tl <br /> - � � l , l�',tG�(.,rz (�'X/ /�7` ..'�'� '�i! C�/ � v- oCY�__ i <br /> LEGAL LOT NO. BL K TRACT OR SUBOIVISION p <br /> DESC. <br /> OWNER'- ) ADDRE55 CITYIZIP PHONE <br /> ( o>��,��� ��r,�f,E.l v ✓�n f3 i 3��C�n ��ZDI <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> E-MAIL <br /> N R R AODRE ITYIZIP P <br /> CONTR.LICENSE N � K ��[�!'��// <br /> � ) !/!� / <br /> USE OF BUILDING HEAT SOURCf CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRIPTION <br /> `������� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Balhtub Forced air syslems <br /> Lavatory(wasli basin) Gas piping <br /> Shower Water hea�er <br /> Kilchen sink 8 disposal Cas(irepl3ce <br /> Dishwasher G2srange <br /> Clolhes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(servicelbar/moplelc.) Exhausl fan <br /> �ackllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking FouMain Boiler <br /> Floor drain Re(rigeration <br /> Grease Irap Woodstove <br /> Roof drains Olher <br /> Oiher <br /> _I <br /> CITY OF EVERETT LOCAL SIILES TAX CODE IS J105 <br /> 1 hereby certify that I have read and examined Ihis applicalion and knew tlie same to be true and correct. All provisions o(laws and <br /> ordinances governing lhis lype of work will be complied with whether specified herein or not.The granling o�a permit does nol presume <br /> to give authorily lo violale or cancel the provision o(any olher state or local law regulating construction or Ihe performance of <br /> construclion.That I am authorized by t ner o hTs proRerty te perform Ihe work for which application is made and I compiy with the <br /> Sta�Coniraclors L rv 18 RCW an 296.200 WAC. <br /> �7 ,p <br /> �/ "� T � � C� � <br /> ig alure ot OwnedConiraclodAuthorized Agent ate <br />