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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857 –www.everetlwa.org I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT p <br /> ,�.�='c> � f� ��� - ���: cr�i>�n7G, 3C'27G%D � ' � - _5 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNERr7 ADDRESS , CITY2IP PHONE <br /> � �: ( (- L��C f 1 '� [ %�Gf%r�1-�"�'.G�l7V �-C�('t{L/��c��� <br /> TENANTNAME ' CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> CONTRACT R DDRESS 1 YI i PH NE <br /> • �' <br /> CONTR.LICENSE# .��,��/t`s.� �� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � Electric _Gas_Other <br /> �,�.' ( `'C� �' ��> �} 1-� — .. <br /> WORK DF,SCRIPTIQh <br /> � ,� , ' � <br /> ��� <br /> � ��- % L � ' � �� <br /> ���� ` .Ii�'��.i'��iC,:��"l ,�i �i ifi� ��4�'71-�C�(, � ll � � �-" <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTl1RE OR ITEM <br /> Toilel _ A/C—air handling unils � <br /> Bathtub , Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas renge <br /> Clolhes washer Cbthes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/c,�.) _ Exhausl fan <br /> 6acktlow prevunter _ Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeration <br /> Grease Irap _ Woodstove <br /> Roof drains Olher_ <br /> Other <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined lhis applicalion and know Ihe same to be true and correcl. �.i�provisions o(laws and <br /> ordinaces govemir,g lhis lype of work will be complied wilh whelher specitied herein or not The granting of a permit does no�presume <br /> to give authcr;y to violate or cancel Ihe provision of any other state or local law regulating consWction or Ihe periormance of <br /> conslruction.Thal I am authorized by the owner of this property to perTorm lhe work for which applicalion is made and I comply wilh Ihe <br /> State Conlractors�aw 18.27 RCW and 296.200 WAC. <br /> � ��� � � <br /> ������� ��f(,' ' C C'/ ;�L!��i�/;' i �� > � <br /> Sic�nalure o(OwnedConlractor/Authorized Agenl��� Dale <br /> L_. ------ �-- �---- J <br />