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PERMIT APPLICA►TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> "s200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� .y�s-,�S <br /> SITE ADDRESS PARCEL TAX I.D.8 I PERMIT M <br /> 33G� P:�cAUu��t� . � � . _�•��, � , <br /> ; , ,r � : <br /> LE.r�A LOT NO. BLOCK TRnCT <br /> �iESC. i `�� � ���1 � � �� • �� �iv�� li � I.� .�T- �� 'i.,l � <br /> OWNER ADURESS GTVZP PHONE 2_�.,_ <br /> y��1/r �� I � ��, - ��rf� ��vE_� `��t� t.� �i81c � �(��I-4�(�%�� <br /> TENANTNAME CONTACTFORPERMI7 PHONE <br /> `J U`JC� I t��-1 A�z�l� C� RI I`��'�� I' I Z�-(c- `r�3Z�I Z� <br /> CANTRACTOR V.����y�� �. ADDRESS�� ��Y` 2���c�rrzir PHONE �`,(, - <br /> 7, I 7 <br /> CONTR.LICENSE A /�L5 C�)� �I� �.�I I I/ J,•;(� '�-./`I I L�_ � �L�-i =�J � , <br /> \ <br /> USE OF BUILDIIIG I — � HEAT SOURCE I CONTRACT PRICE OF WORK I <br /> i ;� , <br /> -` Electric _Gas Otber i t �. <br /> WORK DESCRIPTION <br /> . f ��."' : ...' t j� �J :�' �. ��JT- I (�-'�" �'-C'C��'�7-�- �J i l I�'1 I 1 '.� �.111 � I'•1 <br /> ����J �L�(_ I�-' �� �.-�� I��l= {��i'I� � L � �' t-� � <br /> PLUMBIN(i MECHAIYICAL <br /> NO. 7YPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Ctothes dryer <br /> Laundry tray Ranoe hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Badcfiaw preventer r;,_, Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor droin Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> ' Other <br /> ICITY OF EVEREtt LOCAL SALES TAX CODE IS 3706 <br /> II fiereby centify that I have read and examinr.d this appiication and know the same to be irue and corred. All provisions ot lavrs and <br /> ordinaces governing this type of vrork will be complied with whether speci5ed herein or not.The grenting of a permit does not presume <br /> to give aulhoriry to violate or cancel the provision of any other slate or local law regulating construction or the perfortnance of <br /> construdion.That I am authorized by the owner of this property to peAortn the work tor which appliption is made a,�d I comply with the <br /> State ConVactore Law 18.27 RCW and 296.200 WAC. <br /> i r <br /> . ::. . : ,.� . _. .. ,- lt, . I . 1� . � <br /> �� � ��_( (: ,' y� f �_ ' - �� ��/.Cf ��J <br /> SignaW2 of Ow r/ContractodAath�zed Agent � Da�— <br />