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�RMIT APPLICATI� <br /> CITY OF EVERETT PERMIT SERVICES � `�,3 .0� <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 �7Q,�D� <br /> SITE ADDRESS PARCEL TAX I.D.p ERMIT# <br /> � 2 ? - = C Sini a . ��U" o �o — 0 4 <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION p . � <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �ALiI"�� /-IoMt� ?_ 3G '��-41��+ Av � I�e,,.k �� $��3Z 7_oG 9� i S'�+ 5� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> �aur�a�-��—�'��.� � <br /> c�te� r1�� b4 5--�:1�.,•... 4,, c�31�-�� li 2 � � � � v`� �i�i <br /> CONTR.LICENSE fl <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric (�as__Othor <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> IToilet _ �JC—air handling unils <br /> � Oatiitub _ Forced air sysloms <br /> � Lavalory(wash basin) __ Gas piping <br /> Shower Water healer <br /> � Kitchen sink 8 disposal _ Gas fireplace <br /> � Dishwashcr _ Gasrango <br /> Z Clothes washer _ Clolhes dryer <br /> � Walerhoalor _ Range hood <br /> _ Sin4(service/badmop/etc.) __ Exhaust(an <br /> Backllow pr�venter Haat pump <br /> Urinal Uni�healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Rool drains Olher <br /> Olher _ _ <br /> CITY OF EVEREIT LOCAL SALES 7AX CODE IS J705 <br /> I hereby cerilily that I have read and examined Ihis application and know iho same to be lrue and corcect. All provisions ol laws and <br /> ordinaces goveming this type ol work will be complied wilh whelher spocifi�d horein or not.The granling of a penni�doas not presume <br /> to give aulhority to vio ale or cancel�ho provision ol any other state or f�cal Ia�N rec��latin3 construdion or the pedormance of <br /> construction. Thal I a authorized by Ihe o�mer ol this property to perfurm IYm work lor which application Is m�de and I comply with the+ <br /> Slate Coniraclors l a 9 27 RCW and�96200 WAC. <br /> � ,,,.�• 1_11p7 <br /> Sic�nalur Owne C iV tor/AulhorizedAgent Dn ��; <br />