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P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES 7 �� 3 _v� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.org n <br /> - ---- OJ�-� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.p ERMIT# \ <br /> 27- ' /Ne , ��UD� v /U - 6 l i <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p _ � <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> cir-�� �-lu_Mr� 23G ga-y���+ Av � I�e�-.�- 98��3z �G 94i 5''� S� <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> � .,,,.. ' q� N�. &t ��K- '� 9��� c� 2 f � � G a 9 �G <br /> CONTR. LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric (,��s___Other <br /> WORK UESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> �_ Toilet A/C-air handlin� units <br /> �athlub Forced air syslems <br /> _� Lavalury (wash bnsin) . _ Gas piping <br /> Shower Walor heatcr <br /> _(,r_ Kilchen sink& dispnsal _ Gas fireplar.e <br /> �_ Dishwashcr Gasranc�e <br /> Z Clolhes washer Clalhes dryer <br /> _'� Waler healcr � Ranc�o hooA <br /> _ Sink (scrvir,c!barlmop/e�c.) Exh2ust lan <br /> _ DacklloK�prevenler -- Heal pump <br /> Urinal Unil heater <br /> Drinkinq Founl,iin Boilar <br /> Floor drain _ Relrigeralion <br /> _ Grease trap Woods�ovo <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAJ(COOE IS J105 <br /> I hereby ceritify thal I have read and examined ihis applicalion and know tho same lo be Iruo and correcl. Ali provisions of laws and <br /> ordinar.es governing Ihis lype ol work will he complied wilh whethr,r specified heiein or not.The grantinc�of a permil does not presume <br /> to give authorily lo vio ale or cancel the provision ol any other s�ate or local law regulaling consWction or Ihe performance ol <br /> r.onstruction. That I ai authorized by Iho owner of Ihis propmty lo pertorm the work lor which application is mado and 1 comply wilh tho <br /> Slate Contractors Law 27 RCW anc1,296200 WAC. <br /> ✓ l Q") <br /> Sign:,.�r Owne Cr ilr :torlAulhorized Agent Dal� <br />