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PrkMIT APPLICATIUIV <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 /> � I�� APPLICATIONS ARE ACCEP7ED FROM B AM TO 4 PM ���v`S�U� y � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �� 7 1- �� / � !� <br /> � -�.— <br /> LEGAL IOTN�BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS � CITYIZIP PHONE ,l�Z�_�2_ 5� 5, <br /> � & � �NVES? MENTS �li�'� I1� S^� . ►�E TU�AuP q8z�i �125-232-IS I <br /> 7ENANTNAME CONTACTFORPERMIT PHONE <br /> BA�B�R Sin1GN �-las —232— �55I <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE M �y �� C��U�"��—� <br /> �Y�U <br /> USE OF BUILDING � I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Gleclric Gas Other <br /> WORK DESCRIPTION <br /> ��� �� � � Gl.0 � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE(1R ITEM NO. TVPE OF FI%TURE OR ITEM <br /> Toilel A/C—air hanAling unils <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) Gas pipinc� <br /> Shower Watm heale� <br /> Kitchen sink 8 disposal Gas lireplace <br /> Dishwasher Gasranc�u <br /> Clothes washer � Clothes dryer <br /> W�tcn c�aler Range hood <br /> Sink(servir.ofbadmup'clr..) Ezhaust lan <br /> Backflow preveNer _ Heat pump <br /> Urinal Uni�hoator <br /> Drinking Founl�in . Boiler <br /> Floor drain Rclric�oialion <br /> Grease trap Woodslove <br /> Roof drains Olhoi <br /> _ Othor ------_ — <br /> CITV OF EVERETT IOCAL SALES TA7(CODE IS J105 <br /> I hereby cerility Ihat 1 have read and examined Ihis application and know Iho sama to ba true and cormcL All provisions ol laws and <br /> ordinaces�ovorning this typo ol work will bo r,omplied wilh whother specifiod horein or nol.The granting ol a permit does nol presumo <br /> �o give aulhority lo violate or wncel ihe provision ol any othor slnte or local law regulating consiruclion or the pedortnance ol <br /> conslructioa That�am aulhorized by Iho ownor ollhis prope.rty tc porlorm Iho work for which applicalion is made and I comply with the <br /> Slato Contractors Law 78.27 RCW and 296.200 WAC. <br /> `��-t..� ►e���6 <br /> Signaturc ol OwnedContraclorlAuthorized Agonl alo <br /> � <br />