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P�RMIT APPLICATII�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-�vww.eve�ettwa.org <br /> APPLICATIONS ARE ACCEPTED FR4M 8 AM TO 4 PM �} �6 '� <br /> SIf E ADORESS PARCEL TAX I.D.N C G��,�,^ <br /> �-,Z�6 [�vG2 L °"'' _ <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PIiONE�1z5� � <br /> ��1'i1.1� �L�— <br /> N 2�b r�l,UEI?�L'F�� 1� �UTiQk1�`f J z'�d-015`� <br /> TENANTNAME CONTACTFORPERMIT PHONE ��•7�7� . �1�'�CJ� <br /> �ONI � N E-MAIL <br /> D wU� <br /> CONTR.LICENSE N <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> t � i 11 �.�t�� � <br /> �I�W ��IZ,�1 � _Electric �Gas_Olhor <br /> WORK DESCRIPTION ��}�G�{'.C� <br /> � <br /> ,�, , U� �,,, I,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM N0. TYPE OF FI%7URE OR ITEM <br /> � Toilet i� I' A/C-air handling units <br /> 2 8alhtub: ! 1 Forced air systems <br /> _(p_ Lavatory(veash basin) U'1��( 1 Gas plping <br /> � Shower Z Wator hoator <br /> I Kitchen sink A disposal � lias fireplace <br /> � Dishwasher ti' Gas range <br /> 1 Clothes washor � Clolhes dryer <br /> � Walcr hoater I Range hood <br /> � Sink(sorvice/bar/mop/elc.) � Exhaust fan <br /> � BackOow preventer J- Heal pump <br /> � Urinal -9' Unil healnr <br /> � Drinking Fount�in �D' Boiler <br /> Floordrain � Refrigeratlon <br /> d' Grease lrap � Woodslovo <br /> � Roof drains _ Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES T�V!CODE IS 1105 <br /> I hereby cerilify that I havo read ond examinod lhis application and know lhe same to be lrue and corcecl. All provisions of laws and <br /> ordinaces governing this type ol work will be complied with whelher spocitied berein ur noL The grantlng o(a permit doea nol presume <br /> lo givo aulhority to viotalo or cancel tho provision ol any olher slalu or local law regulatlng construcllon or lhe pertormance of <br /> construclion. That 1 ain authorized by tl�o owner of Ihis propeAy lo pe�forin lhe work lor which applicalion Is mede and I comply with the <br /> Stato Conlractors Law 1827 RCW and 296.200 WAC. <br /> `_� -���� 7 0 <br /> SignnWre of OwnedContraclor/Authori�ed��ent ale � / <br /> 2 <br />