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P�RMIT APPLICATI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32U0 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org �b� �� ,�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D./1 PERMIT# <br /> � � - �C �rN �l1-��� ��" n� 07/ b -oyZ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION k <br /> DESC. <br /> OW ER ADDRESS CITY2IP PHONE <br /> � a��J lLc 'L36i�� - �r� � �An S il�rw��a��L <br /> TENANT N E CONTACT FOR PERMIT PHONE <br /> E�h1AIL <br /> /, `i ^ ^ <br /> CONTR.LICENSEp �WIJ�, / l�`�� �I/)��t% / CI� ��C! I ..)/f� <br /> —! / <br /> USE OF BUILDING �� �^�7 � HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��3�.L�1� — <br /> Elec�dc �as_Olher <br /> WORK DESCRIPTION <br /> FLUMBING MECHANICAL <br /> NO. TYPE CF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> BalMub Forr.ed air syslems <br /> Lavatory(wash basin) (�J—� Gas pipinc� <br /> Shower .� Wa�or healer <br /> Kitchon sink 8 disposal Gas firoplace <br /> Dishwasher Gasrango <br /> Clothes washcr Clothas dryor <br /> Waler hea�er Rango heod <br /> Sink(service/bar/mopletc.) Ezhaus�fan <br /> 9ar.kllow preventer __ Heat pump <br /> Urinal Unil healer <br /> Drinkinc� Founlain _ 0oiler <br /> Floor drain Refrigoration <br /> Grease�r�p _ Woodslove <br /> Roof drains Olher _ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS�105 <br /> I heroby corili(y ihat I havo read and examined Ihis�ipplication and know�he same to be Irue and correct. All provisions ol laws and <br /> ordinaces goveminy this t�-pe oi work will�e complied wilh whelher spocified herein or nol. The granting of a pormit does not presume <br /> lo yive authority lo violato or cancel the provision of any olhor slate or local law regulating wnslruction or the perlormance of <br /> construclion.That I am autho ized by lhu owner o�Inis proporty to pedorm Ihe work for which applicalion is made and I comply with Ihe <br /> Slato Conlractors Law 18.27 C and 2�J�.200 WAC. <br /> � �o . <br /> Si9naWrc of Ownor/ ntrar� ut orized Agenl Dal <br /> � <br />