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� PERMIT APPLICATION <br /> CIT�Y OF EVERETT PERM(T SERVICES <br /> 3200 CEDAR STREET, EVERE7T, WA 98201 I <br /> 425-257-8E10- FAX 425-257-8857 -www.everettwa.org I <br /> A?PLICATIONS P,RE ACCEPTED FROht 8 AM TO 4 PM 3 -' �O --(�� I <br /> SITE ADDRES PFRCE:TAX I.D.# PERM # <br /> �/C�5- ��-� Ys� :, �� ��> /�, ,��, �� ;� �� I ��>>�� '� <br /> LEGAL LOTNO. BLOUK TRACT —�� <br /> oEs�. �o /�:6 >o�s��� <br /> OWNER ADDRESS .�' CITY2IP PHONE <br /> �l �L' Y'l �'- �G't 1t �fY v�/0� J � l/ eY.I <n� 1'� l_- !��i ��/� y�'.�Zb 3 <br /> TENANTNAME CONiACiFOR PERMIT PHONE <br /> � JG7 in � . . <br /> CONTRACTOR ADDRCSS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING Hi_AT SOURCE CONTRACT PRICE OF WORK � <br /> l <br /> ����� �� ��r�,�� �� �����,� <_ �_� ,�Electric _Gas_Other <br /> � <br /> WORKDESCRIPTION �— , • <br /> � ,��n��'�c��-v <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM N(1. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> � Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplaco <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/badmop/olc.) Exhaust fan <br /> � BackOow preventer Heat pump <br /> L'rinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olhcr_ <br /> Olher <br /> — — -- I <br /> CITY OF EVERETT LUCAL SALES TAX CODE IS 1105 <br /> I hereby cerilify that I have read and ezaminod this application and know lho same to ho We and correcL All provisions ol laws and <br /> ordinaces goveming this lype of work will bo complied with whether specified herein or noL The granting of a permit does not presume <br /> to give aulhority to viplato or cancei the provision of any other stato or local law regulaling construclion or tho pedormance of <br /> I conslruction.That I am authorized by tho owner of this property to pedorm the work(or which apptication is made and I comply with the <br /> S ate Con �act fs L w�18.27 CW and 296.200 WAC. <br /> ,�z���y� � 3� �Z <br /> ,�i nature of OwnedContracrodAuthor.zed Agent Date <br /> i� <br />