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PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwva.org <br />`` n <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADD ESS <br />P <br />PARCEL TAX I.D. N RMIT N <br />5G o-20t)40 <br />LEGAO, L9T N BLOCK TRACT OR SUBDIVISION N <br />DESC. G <br />ADDRESSCITYIZIP PHONE <br />OWNER 7TENANT <br />�14 <br />NAMEE-MXL I CQNn CT�QRR�MIT PHONE (gJZ-1Lj <br />(i�•M,{jn,,(�,,(/Y.[•(HLf •�•u�I G"" Citl,4,4) <br />C Jr17. CENSEa ; <br />BUILDINLG HEAT SOURCE CONTRACT PRIICCE� OF WORK <br />FBUILDING <br />Eleclric/K- Gas _ Other i���/r n 0 <br />WORK DES RIPTIO r !Alan z i,13('4 6" <br />0/1Wi �91.�N�T. <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />— <br />A/C — air handling units <br />Forced air systems <br />— <br />_ <br />Lavatory (wash basin) <br />Shower <br />— <br />— <br />Gas piping <br />Water heater <br />_ <br />_ <br />Kitchen sink 8 disposal <br />— <br />Gas fireplace <br />Gas range <br />_ <br />_ <br />Dishwashei <br />Clothes washer <br />_ <br />— <br />Clothes dryer <br />Range hood <br />_ <br />_ <br />Water heater <br />Sink (service/bar/mop/etc.) <br />— <br />— <br />Exhaust fan <br />Heat pump <br />_ <br />Backflow preventer <br />Urinal <br />— <br />— <br />Unit heater <br />_ <br />Drinking Fountain <br />Floor drain <br />— <br />— <br />Boiler <br />Refrigeration <br />_ <br />_ <br />Grease trap <br />— <br />Woodstove <br />Other <br />Roof drains <br />— <br />_ <br />Other <br />— <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />ordinates <br />I give aut 'ty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />I authorized by the owner of this property to pe form the work for which application is made and I comply with the <br />construe' n at <br />Stale n ctors L 8.27 RCW 00 WAC. <br />ign lure o caner/Contra ulhodzed Agent Date �L <br />