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PEr2MIT APPLICATIanI <br /> CITY OF EVERETT PERMIT 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 <br /> SITE ADDRESS PARCEL TAX I.D.It PERMIT p <br /> , � z C;�� � I <br /> LEGAL L01 NO. BLOCK TRACT OR SUBOIVISION M <br /> �ESC. <br /> OWNER AUDRESS CITY2IP PHONE 42S 35S A� 3 <br /> � �2.5 CCt,S C LI� C �/ic'r F.+ -� �l � �ir52c3 3 <br /> TENANT NAME ONTACT FOR PERMIT PHON� ,3�5 Odf' ' � <br /> �AZ`jb� �66S�V1Q—�Q6��Q.�,� E�MAIL <br /> CONTR.LICENSE# j J�U���� <br /> `/V <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> j��nI _Eloclric _Gas_Olher <br /> WORK DESCRIPTION <br /> �•���ilS�7 �I�����1 �� G'�-- <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Tuilet A/C—alr handling unils <br /> Oalhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W aler healar <br /> Kilchen sink 8 dispusal _ Gas liroplaco <br /> Dishwasher � . Gas rango <br /> Clothes washer 1' _ Clolhes dry�r � <br /> Wator hoalcr � Rango hood <br /> Sink (serviceNadmoplelc J f^�1 � _ Exhaust(an <br /> Oack(low prev�nler ��� � �� � � _ Heal pump <br /> Urinal Unit hoater <br /> Drinkinq Founlain � _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstova <br /> Roof Crains _ Other <br /> Othor — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 9105 <br /> I horeby corili�y Ihal I have road and�xamined Ihis application and know lho same lo bo lruo and correcL All provislons o(laws and <br /> ordinaces govmning Ihis type of work will be complied with whether specified herein or nol Tho granting o(a permil does not presumo <br /> to yi�-e authority lu violale or cancel Ih�provision ol any other slale or local 12w rogulaling construction or Iho podormanca ol <br /> consh uclion. That I am authorized by tho owner ol this propo�ty to pedorm!he work for which applicalion is mado and I comply wilh Ihe <br /> Stalo C �ors La . CW and 296.200 WAC. <br /> " � � � �- l7- �� <br /> Si aWr oriContraclodAulhorized Agenl Dala <br /> I. _ _ __ - -- - \lV-- <br />