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PtRMIT APPLIGATI(�N <br /> CITY OF EVERETT PERIVIIT SERVICES � _�3 _u� <br /> 3200 CEDAR STREET, EVERF;TT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P�7.� <br /> —_�� <br /> SITE ADDRESS PARCEL TAX I.D.p y PERMIT p <br /> SL� — E LAS�,vo �,! '� �" !I/3oS�� - a4�' ) <br /> LEG4L L^7 NO�� BLOCK TRACT OR SUBDIVISION U � <br /> DESC <br /> �WNER ADDRESS CITY2IP PHONE <br /> i�crFic /-/a M�__ Z3b82 — /�� /'�u1 /�-e�,� g8�3z �G _ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> �-����-__�,��,_.�;---�� , � � �, 8 )6 -a�6 <br /> CONTR. LICBNSE k <br /> _____ _—_—._..___—____—__-- _--- — <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICt OF WORK <br /> Elor,lnr. Gas Othm <br /> WORK DESCRIPTION <br /> --- - --- PLUMBING --- — --- ------MECHANICAL <br /> - <br /> NO. TYPE OF FIIfTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � T�ilcl ____ A/C- air handlinp units <br /> /� �athtub _ ForceA air syst�ms <br /> �Z� Lavatory(wash b�sin) _ Gas pipiny <br /> Showor Wa�cn c�atr.r <br /> � Kilr.hun sink 8 disposal _�__ Gas lireplace <br /> � Dishwashcr Gas ra�ige <br /> ClotLes w�sher __ Clothes dryor <br /> Wa�er healer __ Range hood <br /> Sink(scrvicelbar/mople�c.) __ Exhaust lan <br /> Dackflow preven�cr Hoat pump <br /> Urinal Unit hea�ar <br /> Drinkin� Foimt:�in _ Boiler <br /> Floor drain Rolrigeralion <br /> Grease irap Woodslove <br /> Roul A�ains O�hei <br /> --- Olhcr --- — <br /> CITY OF EVERETT LOCAL SALES TA%COOE IS 77':5 <br /> I herebp cenlify Ihat I have read and r.xamined inis�pplicahon and 4now Ihe same lu be Irue and wrrecl. All provisions of laws and <br /> ordinnres c7ovaminq ihis type of word wiP be compiieA H ilh whelhar specilied h��rein ur noL The granting of a permit does nol presume <br /> to yror�mliurily lo virdnle or c.�m:e� Ihe provision ol any othin r�l,de or lucal la�v regulatiny r,ons�ruclion or�he perlormance ol <br /> cnnstrud�on Tha I am authori��d 6y ihe owner ol lhis property lo porinnn tlw work lor which application is made anA I comply wilh ihe <br /> 3lale Contrar,tors -aw 1H27 RCvV anA 296100 WAC <br /> / nl' <br /> Signa u o�� i u� mirar.lur Au�horized Agenl ���D2� <br />