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� --- <br /> � PERMIT APPUCATION <br /> II CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810- FAX 425-257-8857-www.everettwa.org I <br /> APPLICATIONS A�tE ACCEPTFD FROM 8 AM TO 4 PM I <br /> � SITE ADDRESS PARCEL TAJ(I.D.!i PE/fJ,MI� � <br /> � _ _ '_„ e 'o� �DC)•a q(", . � hDo 11 d ��l� <br /> �ILEG�—LOT NO.' BLOCK TRACT OR SUBOIVISION N � I <br /> DESC. � ; ' �� :. � ' ' .nI� <br /> OWNER ADDHESS CITV2IP PHONE <br /> -r <br /> ' � ,. . .. f , ' _� �f-� , ' t �` C F 2 e� ���! �, ��_� <br /> TENANT NAME CONTACT FOR PERMR U -r-�, PHONE �, , � ;, � � � <br /> -- ' � . � K��-(f r.1 � �i .,. '� E-MNL � � . ��i � 'iA� <br /> � �' , i � <br /> '��A�T� ' p � E 1 Y IP = � � <br /> COHTR.LICENSE N ` � � ' � <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WOqK �I <br /> l. �C, I <br /> .,. _Electric �Gas_Other �_, ` i'���^. — <br /> __"7 <br /> WORK DESCRIPTION - � <br /> - � - �- ' - � _ �-. . '_ , � .�. . �C ; _ .. � <br /> ' PLUMBING MECHANICAL <br /> NO. TY7E OF Fl%TURE OR ITEM NO. � TYPE OF FlXTURE OR ITEM <br /> Toilet _ aC-air handling units <br /> i _ Bathtub = Forced air systems <br /> Lavator�(wash basin) Gas piping <br /> II _ Shower _ Waterheater i <br /> Kitchen sink&disposal _ Gas fireplace I <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink(service/bar/mopletc.) _ Eshaust fan <br /> Backflow preventer __ Heat pump I <br /> Urinal _ Unit heater I <br /> DrnkingFoun�ain � __ Boiler , <br /> Floor drain _ Refrigeretion <br /> � Grease trap _ Woodstove <br /> '� Roof drains _ Other <br /> Other _ — <br /> . I CITV UF EVERETT LOCAL SALES TA%CODE IS 310.5 <br /> I <br /> � I hereby ceritify that I have read and examined ihis application and know the same to bs true and correct. All provisions of laws and <br /> ' ordinaces goveming thic type of work will be complied with whether specified herein or not The granting of a permit does not presume I <br /> to give authoriry to viol�te or cancel tHe provision of any qJher state or local law regulating construction or the performance of <br /> �, constmction. That I authorized by the ow�€T of this�prop2rty ro perf�rm the work for which application is made and I comply with the <br /> i State Contr;ctors aw 1827 RCW and"��6200 WAC. J i� � <br /> , - ; . . � -,--�r �/�{`�� <br /> v�' Signah�re of . ' ontractoUAu horize �Agent Date �' <br /> Z <br />