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2-ai -o � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX a25-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS -� ' PARCEL TAX I.D.N RMIT p <br /> n i �- s � ' O�C - /Z <br /> , <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENAN;•NAME CON7ACT FOR PERMIT PHONE <br /> �i! � 7 ; � <br /> -�.'r � — <br /> CONiRACTOR ADDRESS CITY2IP PHONE <br /> .1--�,na �L� <br /> CONTR.LICENSE M <br /> USE OF BUILDING — HFAT SOURCE I CON'fRACT PRICE OF WORK <br /> Electric _Gas Other <br /> WORK DESCRIPTION � � �} <br /> ' � ��y�-,�� C�' ,�ltl2 :�lti��njL - Y�O <1/�iU✓��C/L�LX✓ <br /> L��.?�Cl��� <br /> ,�.!1Q.f w��i <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilot A/C-air handling units <br /> ��Ihtub _ Forced alr systems <br /> _ Lavatory(wash basin) I _ Gas piping <br /> Showor W ator healer <br /> Kilchen sink 8 dis{x,sal _ Gas(ireplace <br /> Dishwashor __ Gasrange <br /> Cblhes washer _ Clo�hes dryer <br /> Wa�er healor Range hood <br /> � Sink(servicelbadmoplelc.) = Exhausl(an <br /> Backllow proventer Heal pump <br /> Urinal __ Unit heater <br /> Drinking Founlain _ Boller <br /> Floor drain Rotrigeralion <br /> Groaso lrap _ Woodstove <br /> Roof drains _ Olher <br /> Otliar _._ — — <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I heroby cerili(y that I have read and examined Ihis application and know lhe same lo be true and correct. All provisions of laws and <br /> ordinaces governing this type ol work will be complied with whelher specified herein or not.The grant;�p of a permil does nol presume <br /> lo givo aulhority to violale or cancel the provision ol any other slate or local law regulating consWcG:.�.o•Ihe peAortnance ol <br /> construction.That I am authoriz�d by the ownor of Ihis propr.rty lo perform Ihe work for which applicatiu��s made and 1 comply wi�h the <br /> Sla�o Conlr�clors Law 18.2Z�RCW�nd 29�.�90 WAC. <br /> t � � .� I U �v <br /> � l `� CCf.uN� �� ,: r'��..<�l'�A,.. ' � <br /> nature o(OwnedConlractor/Authonzed Agont Dat <br /> � <br />