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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.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.A P,ERMR N/ <br /> c i ":�t.� y � �, %� �.rx�� u 1, l ��)"[x�.�,3�,01 � 7��t� � oo� <br /> LEGAI LOT NO. BLOCK TRACT OR SUBDIVISION/ <br /> DESC. <br /> O N R DRESS CITY I � > , H <br /> �,%7,ri.l' %� C_ !_ i" ;�'v ,��.�,y/a�:� .S: r�.f;<<<�-� � /—'s .>rJ'—yfsy <br /> TENANTNIWE I CONTACTFORPERMIT PHONE . <br /> , , � I � 75 cF;f- -J`:ii �Y�_�, . <br /> �c%C � 4 ��w,,�� ; i�: � b� �T��!�5�+�' e�uL L��7:1F./��as,,.,t�•N <br /> �G�'�'%� SS.�e� `Zf -ri.;.��;ST. �.�` `'��/- y15 'Yb'-��y <br /> CONTA.UCENSE N - . <br /> ;�.S.�v��� ,�.� - %� �� ��t�/ <br /> USE OF BUILOING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � G <br /> � C .l.r.`. Giti� • :� } Eladric /C G s � Other ¢%�� �i�- �-_- � <br /> �" / <br /> . <br /> WORK DESCRIPTION <br /> �� CCi>x s:�=•L'� � •i .? ( a;? C�.•L!-l)•LC�•�� � <br /> .;t�k .�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TVPE OF FlICTURE OR ITEM <br /> Toilot A/C-air handling units <br /> __ Bathtub _ Forced air systems <br /> Lavalory(wash basiN Gas piping <br /> __ Showar _.. Waterheate� <br /> ___ Kitchen sink 8 disposal __ Gas fireplace <br /> Dishwasher �'� � Gasrange <br /> ___ Clothes washar � L Clothos dryer <br /> Water hea�er � __�. Range hood <br /> � Sink(service/bar/mop/etc� � �I" Ezhaust fan <br /> __._ Backllow prevontei ��� _ Heat pump <br /> _____ Urinal � Uni�hea�er <br /> Drinking Founlain Boilor <br /> Floordram ___ Relrigera�io� <br /> Grcasc trap Woodstove <br /> Rool drains Other <br /> O�her <br /> CITV OF EVERETT LOCAL SALES TAf(COOE IS 3105 <br /> I hereby ceritily that I have read and examined Ihis appl�cation and know Ihe same to be true and correct. All p�ovisions of lews and <br /> ordinar.os govoming�his typo of work will be complied with whalhor specilied herein o�not.The gren�ing ol a permi�does not presume <br /> to grve authority to violate oi cancal Ihe provision ol nny o�he�state or local law regula�ing construction a ihe perlormance ol <br /> consVu That I am authmized by the�owner ot Ihis property to pedo�m the work 1or which application is made and I comply with the <br /> State ontra ors law 1827•RCW,{�nd 9 . O WAC. <br /> � � � ��,. <br /> Si e�l n ontra r/ oriz gont ate � <br /> � ,,, ,� /{ L � l,c�c[: •'._ I Z <br /> � <br />