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� _ - - P - - - -------- -- - ------- - - <br /> � ERMIT APPLICATION <br /> CITY �F EVEZETT PERMIT SERVICES <br /> 320U CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org ��) �6 _�S, <br /> � <br /> i APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D,p pERMII p <br /> ' 1 S ' .lua �1 � ���c� "�€� � oo cbs ov I�)���i���� <br /> iLEGAL LOT NO. BLOCK TRACT ' , . <br /> DESC. � � �-' I ' . /� ; I � <br /> ' OWNER ADORESS CITY2IP PHONE <br /> . . . � � � . ' � � . . , � i . . . , I . � � ! - �i� � . <br /> I TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ! ,. <br /> ICONTRACTUR ADDRESS CI7Y;ZIP PMONE <br /> I CONTR.UCENSE N O� � .A , <br /> /�-�'✓ <br /> I <br /> IUSE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> i � �� � _. Electric �Gas Othor <br /> I WORN DESCRIPTION � , <br /> I � I <br /> � PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE UR ITEM <br /> I � Toilet AIC–air handling units <br /> � � Bathtub i Forced air systems <br /> ' � Lavatory(wash basin) � Gas piping <br /> � Shower Water heater <br /> , j_,_ Krtchen sink 8 d�sposal ._j _ Gas tireplaco <br /> ' Uishwasher _ Gas range <br /> I I__ Clothos washer Clolhes dryer <br /> �, _�_ Lavndry iray . � Rango hood <br /> I _ Sink(servlce�badmoplelc ) � Ezhaust lan <br /> ' __ Backilo���preveNer 4eat pump <br /> i _� Unnal Unillieater <br /> i _. Drinhing Foimlain __ Boiler <br /> . _IFloor drain .= Refrigeration <br /> Graase Irap Woodslovo <br /> �, Roof drains ____ Other__ _______ I <br /> �� Other ...____. _ <br /> I CITV OP EVERETT LOCAL SALES TAX CODE IS]705 <br /> I <br /> �' I hereby cemify Ihat I have read and exammod Ihis applicahon and know Ihe samo lo be tme and covact. All provisions of laws end <br /> ordmaces govr!mmg Ihis type ol work wBl be complied wdh whother specihed herein or noL The grenling ol a permd does not presume � <br /> � to give authonty�o wolate or cancel�he prowsion of any olher state or iocal law regula�ing consvuction or the peAormance of I <br /> ', construction. That I am authonzed by tho owner ol this propeny to pedorm ihe work lor which app6cation is made and I comply wilh ihe I <br /> ' Stat�.6�onlraclors I.��w 1827 R nd 29620D WAC. I <br /> ��X�c� ����� ���3,��(la' _ ! <br /> � n�me ol Ow�onlrac�or ulhorized A nl Date <br /> , �"'`) ,,C �,�j�Cl�}� �2. <br /> ' _ _ (, _ __. _ -- - - — - --- ---- __ _---- <br /> � � ��� <br />