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PERMIT APPLICATION <br /> CITY OF EVERETT PERiIAIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM!AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT M <br /> Q� � lX)C,' - CO <br /> IEGA LOT NO. BLOCK TRACT OR 9UBDIVISION N ,.,r Q� � 2-� 7�, <br /> DESC. z 'U . �� V'� 27✓P" (l�2 � � V� <br /> OWNER l.DDRESS CITY2IP PHO E <br /> �I.o�� rt � 2�.t.��otv l �008 3q�er av � ���o,r�r �,u�- 4� � <br /> TENANT NAME I CONTACT FOR PERMIT PMONE <br /> E-MAIL <br /> CONTR.LICEN9E N <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE Of WORK <br /> Electric Gas_Olher <br /> WORK DESCRIPTION <br /> `�.mo -- �roN� pozch �,v/1�v5- C���%' <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTUHE OR I1EM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C–alr hendling units <br /> Bathlub Forced air syatema <br /> Lavalory(wash busin) Gaa piping <br /> Shower Water healer <br /> Hitchen sink 8 disposal , Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater , Range hoad <br /> Sink(service/bar/mopletc.) Exheuet lan <br /> Backflow preventer Heal pump <br /> Urinal Unil heater <br /> Drinkinc� Foun�ain Boiler <br /> Floor drain Refngeration <br /> Grease trap Woodslove <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL 9ALE8 TA%CODE IS�106 <br /> I hereby certify that I have read end examined�his applicalion and know Ihe same lo be true and corred. All provislone ot lawa end <br /> _ordinapces governing this lype of work will be complied with whelher spacified herein or not.The prentinp af e pertnit doee nol preeunre <br /> lo give aulhorily lo vidate or canr,el tho provision ol any other stete or local law regulaling constructlon or the perlormanCe of <br /> construction. That I am authoriz id by Ihe owner o(�his property to peAorm the work for whlch appllcatfon ia made and I comply with the <br /> Stale Contractors Lew 18 27 P.CW and 296.200 WAC. <br /> � ` �- lo <br /> ,� q— <br /> Signa ur o i n�zctor/Authonzed Agenl Date <br />