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T <br /> P�RMfT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 7� �3 -07 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��7.�D <br /> SITE ADDRESS PARCEL TAJ(I.D.p PERMIT N <br /> 5 Z �7 � E C_�iAJo � � �" v IU - 64� <br /> LEGAL LOT N0. BLACK TRACT OR SUBDIVISION 11 <br /> DESC. <br /> �WNER ADDRESS CITY2IP PHONE <br /> �t�/=�c �-�t �>�� Z368L – �1/0�l /�uS J�.E'��4 g�e32 '206 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E�MAIL <br /> ��,-4 �r�---� —� <br /> CONTR. LICENSE p �i ��� g )6 -°g6 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Flectrir, Gas Olher <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> [ Toilcl . A/C- air handling unils <br /> � Bathlub Forced air systems <br /> �Q Lavatory(wash basin) _ Gas piping <br /> Shower Water heator <br /> � Kitchr.n sink 8 disposal _ Gas fireplace <br /> � Dishwa.:hm _ Gas range <br /> � Clolhes washer Clolhes dryer <br /> Water healer _ Ranc�e hood <br /> _ Sin;:(servicc/badmop/olc.) Exhaust lan <br /> Backllow prov3nter Hoat pump <br /> Urinal Unit heater <br /> Drinking Founta:n Boiler <br /> Floor drain Relric�eralion <br /> Greaso Irap Woodstove <br /> Roof drains Olher <br /> O�her <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J103 <br /> I hereby cerility Ihal I havo read and ezamined lhis applicalion and know iho same lo be irue and wrrecL All provisions ol laws and <br /> ordinaces yoveming ihis type of work will be complied with whe�ther specilied horein ur noL The granting of a permil does no!presume <br /> to give authorily to violale or cancel Iho provision of any olher slalo or local law regulating construcllon or lhe pertormance of <br /> construction.That I am authorized by Ihe owner ol this propeAy lo portorm the work lor which application is made and I comply wilh the <br /> Slnlo Contractors aw 7827 RCW and 296.200 WAC. <br /> � c�.,�.� ���� <br /> Signa e ol r nlractorlAuthonzed Agent Dalo <br /> � <br /> I -- .._ _ ----------- — <br />