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P�RMIT APPLICAT�IC.�� <br /> CITY OF EVERETT PERMlT SERVICES <br /> 3200 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 - DEBIT& C'REDIT CARDS ARE NOT ACCEPTEp <br /> SITE ADDRESS PARCEL TAX I.D.A PERMIT p <br /> ��as� � oad � - G � ii - nv� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A DRESS CITY/ZIP PHONE <br /> (,'v1���L � �' �� C. <br /> TENANT NAMG CONTACT FOR PCRMIT PHONE <br /> I�—.N�. �-�I.�la��c� �('�� �i• '_/�?� <br /> CONTRCCTOR�//��/� a.`� r ' <br /> � ��I AOORESS CITY2IP/` PHONE� / <br /> f.ONTR.LICEN5Ef1 �Ol� �J�J" I �"YW1��^- .\`� �-,,j�� <br /> �LIS�IS 7 �k� `��/�� ��o/er� <br /> USE OF BUILDIN� I — HEAT SOURCE I CO��C�ICE OF WORK <br /> ElecMc Gas Olher <br /> -- — �G, <br /> WORK DESCRIPTION <br /> ��/�Zl//�n� 0�"@�° //� >%� �`2-��/�f� -� /�'�� <br /> �� c� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—airhandlingur.its <br /> _ 8athtub Forcedairsystems <br /> _ Lavatory(wash basin) Gas piping i <br /> _ Shower Water healer <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> ,_ Laundry tray Range hood <br /> _ Sink(service/badmop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> i _ Unnal Unit heater <br /> I Drinking Fountair Boiler <br /> I _ Floor drain Refngeration <br /> Grease trap Woodstove <br />� = Roof drains � Other ) �("�'/Q,� 5'�� . <br /> Other — <br /> ICITY OF EVERETT LOCAL SALES SAX CODE IS J105 <br /> i� I hereby ceritify thal I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this rype of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction t I am authorized by the owncr of this property to perform the work for�vhich applicalion is made and I comply with the <br /> IStat/GortErac��s Law 18 ClN ap 29ti.200 WAC��� <br /> � � �/�' � D '_��U J� <br /> i ..ign f Owner/Co acton orized Agent Date l <br /> i � <br />