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� �- <br /> PERMIT APPLICATION <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 /> APPIICATIONS ARE ACCEPTEO FF10M B AM TO 4 PIiA �0�3p�D9 <br /> SITE ADDHESS PARCEL TAX I.D.A RM j R �� <br /> Ihl � � 00 ' <br /> LEGA LOT NO. BLOCK -T�R-ACT OR BUBDIVISION R "� <br /> DESC. (O OOI II '.R S' ` `A <br /> ��p ADDRESS �� CITY2IP PM E <br /> TfL¢EL A�i S 141R I ' �AVNo �n F�rrr-iT `�JZOi Ur,�..� ,N <br /> TENANTNAME <br /> CONTACT FOR PERMIT �d� PHONE��j A�SS�'3 <br /> �i-$��nl��� n E�MIAIL VOirvF�l�(�l�(`� <br /> -� 'A�A <br /> ���QIVS"T�UGl10N <br /> COHTR.LICENSE I Z�� ���T1 �h= � <br /> HI�N.001=1�IS��1� CfTZ �O� 4L5 �`j� /e�l3_ <br /> USE OF BUILDINO I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> L+ ,���� �n,11i � ��,� �,Electric _Ges__Other `����U <br /> JI <br /> WCfiK u'cS�.Rt��iGtl <br /> RC,mcvE c�PU�cc ENneE.Mai�� �:F,�7P�^i+itD��.Tu �i�'. <br /> Ncw I�rnc. L,v�rvv- SapcE, '�rraw� Vnw�S�cy� T aE <br /> �ERwcEi � �c�A��t D IC�7u+6U •:�cf_�ttfc B�DRoobl mI2n•1 ��erJ�t <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FU(TURE OR ITEM N0. TVPE OF FU(TURE OR ITEM <br /> Toital _ NC-air harxlling units <br /> Balhlub _ Forced eir systems <br /> ]_ Levatory(wash basin) __ Ges piping <br /> � Showor _ Wator Iwater <br /> � Kitchon sink 8 disposal _ Ges lireplaco <br /> � Dishwesher _ Gas range <br /> Clothes washer _ Clolhes dryer <br /> Water hoalar Rango hood <br /> � Sink(sorvicolbar/mop/etc.) � Exhaus�lan <br /> Backflow prevonter _ Heal pump <br /> Urinal _ Unil hoeter <br /> Drinking Founlaln _ Boiler <br /> Floordrain _ Refrigeretian <br /> Greaso trap _ Woodstove <br /> Roof drains _ Other <br /> O�har — — <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hnreby caritify that I have read and examinod Ihis application and know Ihe samo to bo Irue and correct. All provisions ol laws and <br /> ordinaces governing Ihis typo of work will bo complied with whetha�specified herein or not.The granting ol a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating conslruction or the perlormance ol <br /> construction.Thal l am authorized by the owner ol this proFoAy lo perfoim Ihe work lor which application is mede ard I comply with the <br /> State Conlractore Law 1827 RCW and 296.200 WAC. <br /> •- " �. 11 v7 <br /> ignature o r� onlractor/ u� onz gent ete <br />