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FtRMIT APPLICATIt�N <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 /> SITEADDRESS f�Y � F�/ �uA SJ�Of� PARCELTAXI.D.# �eGTa C <br /> � � E ��,���N v r� � � <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CIN21P PHONE <br /> / S�'44�V <br /> ' j r �� 'E �IfC(Zti.oN fL si�eN� rrS sf �/�a-,rou✓cr u-n � 36�� a�S'/-Gy�� <br /> �TENANT NAME CONTACI FOR PERMIT PHONE <br /> � -7-�) � �/ I �, ,,� p <br /> � � il+.M +J�cL1` �' — E-MAIL <br /> CONTR.LICENSEA .��� -� _ ��� ,` �,� I��� � D�'•'�'�� <br /> /r <br /> USE OF BUILDING , HEAT SOURCE CONTRACT PRICE OF WORK <br /> �,��Q _[lectric _Gas.__ Other _—�'� <br /> WORK DESCRIPTION <br /> �£µc�UEvl /� tk� i �l,_� , r�� , �� �� u.. cvaCL <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM17 <br /> Toilcl �------� — !VC-air handliny unils <br /> F3atlitu� Forced air systems <br /> -- Lavalory (wash basin� _ Gas Piping <br /> I Show�r _ Waterhealer <br /> Kitchen sinA& dispos,il _ Gas�ire�dace <br /> I Dishwashcr _ G�srango <br /> ; Clothes washer __ Clo�hes dryer <br /> I Walen c�ater __ Rango hood <br /> I Sink(scrvicelbadmoplcic.) ___ Exhausl lan <br /> Backllow prevenlm ____ Heat pump <br /> I � Unnal Unil healer <br /> � Dnnking Founlain _ �oiler <br /> Floor drain _ Relrigeralion <br /> ! -- Woodslovu <br /> , Grr.ase lrap — <br /> ' Rool drains Olher <br /> -- Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby r.erilily ihal I have read and ezamin�A Ihis applicalion and know Ihe sam�to be lruo and correcL All provisions ol laws and <br /> orAinacrs yoverning Ihis lype ol work will be complied with whelher sp�cified herein or not.The gran6nq of a permit does not presume <br /> to give�ulhority to violate ur wncel Ilm provision ol any other slale or bcal law regulaliny conslruc�ion or Ihe pertormance of <br /> construclion. Thal I am aulhorited by Ihe owner of lhis property lo pedorm Iho work lor which applicalion is made and I comply wilh�he <br /> � �la�e Contrylors Law 1ti.27 RCW and?'J6200 WAC. <br /> � � - -�-�. <br /> I �nalure ol wnedCon ractodn�ino � Pd nyer,� ate <br /> Y <br /> � � �---------�--- ---- -- .._.._ - <br />