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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857 - www.everellwa.org <br /> l� � �5 - �J <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT M <br /> ,Z����N b lL-,� 3°" — --�.? � -U <br /> LEGAL LOT NO--- BLOCK TRACT OR SUBDIVISION p <br /> DESC <br /> �OW ER AUDRESS CITY2IP PNONE <br /> A��_���� 236�z-����A� S �(.�.ti,�c�A9aa�Z <br /> TENANT N�� E CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> �OFTRACTZIh_.__—___—__._____--_A�bi2E�,S____ ___—__----_C Y-7f 1Z1�'--PF10A <br /> / (i <br /> CONTR.UCENSE p (�� � / 1��� <br /> __—_--. . __—___—__. _. .__ ._ . -_ - - - <br /> USE OF BUILDING I1EAT SOURCE CONTRACT PRICE OF WORK <br /> Ilcr�nr G;u Olher <br /> ___—__ ._. _._____.._ -_____. . ._....____ . .__ . _____.___....____-___-_.-- ____-_.—_-_ <br /> WORK DESCRIPTION <br /> -----_ .__ . _ . ._ - - - � - ----------------- ----- <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF FI%TURE OR ITEM NO. TYPE OF FIxTURE OR ITEM <br /> —-TuJe�--------- ----- � -- NC- air handling unils �- <br /> _ Ci:dhlub _� Forr,ed air spslm»s <br /> _ Lavalory(wash I�asin) Gas pipiny <br /> Shower N'aler hea��r <br /> _, Kilchen sinV 8 dispcsnl � Gas Grepl:ice <br /> Dishwasher __ Gasran�c <br /> Clolhes wash�r Clothes dryer <br /> _ �Naler hoaler Ranga hooA <br /> _ Sink(scrvicelbar/mop/r.tc.) Exhaust lan <br /> Dackllow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Founlain Boiler <br /> Floor drain Rofrigeralion <br /> Grease ir:,p Woodslovo <br /> Rool drains Olher <br /> Othor — -- <br /> CITY OF EVEREtT LOCAL SALES iAX CODE IS J105 <br /> I hereby cerilify Ilial I have rnad and oxamined Ihis applicalion and know lhe same lo be true and corroct. All provisions o�laws and <br /> ordinaces{�overniny Ihis lype o�work will be complir.d wilh whelher specilied herein or not.Tho yranling of a permil Aoes not presumc <br /> lo flive aulhority to viol.do or cnncr.l Ihe provision ol anj olhur slate or Iw:al law regulaling conslruc�ion or the perlormanco of <br /> const«idion. Th�l I an authorized hy Ihe o�vner ol Ihis �❑nperty to perlunn Ihe work lor which �pplication is made and I comply wilh Ui� � <br /> Sta�e CuNraclnr5 Laa� N.'] RCW nnA 236.200 N'AC I <br /> Y � l � <br /> r -�� —�-- <br /> SignaWru wncr/ ' i tra . �r��u�hu�ized AgeN ---- - - a�e <br /> I ` <br />