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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -vnvw.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �C ✓�3 �� <br /> SITE AUDRESS PARCEL TAX I.D.p PERMIT q <br /> _ z� - -��s,N�,� 3� _1�.-�- <br /> i.ectii LOT N0. BLOCK TRACT OR SUBDIVISION p �,�p7 �p _d�/y <br /> �ESC. -----�— <br /> OW ER ADDRESS CITY/ZIP PHONE � <br /> TENA�NTN 'E ��J�LC._�_L36bL�`7�7�/4" J__��Q� I G7/` l�.�L — --_ <br /> ICONiACT FOR PERMIT PHONE <br /> E-MAIL <br /> �ONfTiA�Tbk---_ ---AbbTt€�s—_ �+FTbR€—_ <br /> i <br /> CONTR.LICENSE k l . `l�L-�� <br /> _—_ —.__.— _ .___ _—__._ _____ _.— _—_ <br /> __ — _ <br /> USE OF 6UIlDING fiEAT SOURCE I CONTRACT PRICE OF WORK <br /> _ Flr.r Iric Gas (llher <br /> —_—_. ___..__._ _ __.._ _ . ..__. _— . . . _—._�___—_—._- _—.-. <br /> .__—_. ._. __ __ _. <br /> WORK DESCRIPTION <br /> ------_. --------- - - - -- . ._._. ---._. ..----- -- -- <br /> PLUMBING MECHANICAL <br /> NO. TYP[ OF FlXTURE OR ITEM11 NO TYPE UF FIXTURE OR ITEM <br /> —.—__—_ _ ___ _ .__._.__.- ___.__.__. _______ _- ___ ____________ <br /> —_- Toilet NC - ��rt handlm,� unils -- <br /> -- Balhlub _� Furr.ed air syslenu <br /> -- Lavalory(wash basinl Gas pipiny <br /> -- Shower Watcnc�atrr <br /> __ Kitchen sin6 8 dispusal �� Gas Gmpl�v,e <br /> -- Dishwashm Gas rangc <br /> ___ Clolhes washcr � Cbfltes drym <br /> _ Wate�hc,dcr Ran�c hood <br /> ___ Sink (servirc/badmo���cic.) Sj Exhausl lan <br /> _ DacY,flow prevmi�er Hea�pump <br /> _ Urinal Unil healcr <br /> _ Drinking Fountain 9oiler <br /> _ Flnor dr�in Rclrigeralion <br /> _ Grcasc Irap Woodslov� <br /> __ Rool drains Other <br /> Other --- - — <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br /> I herei�y r.erildy Ih;il I have m�d and�xaminr.d this applicatiun and know Ihr, s;�me lo be Iruo and corrocL All provisions ol laws and <br /> ordinar.cs govr.rniny lhis fyp�o(work will be complied���ilh whMher specilied herein or not. Tho granling ol a permil doas nol presume <br /> lo gi�e �+uthunty lo violalre or cancel Iho provision ol any uthor slate or Iecal law regulating construclion or Ihe pedormance of <br /> cunslruclion 7hat I an aulhorized by the owner ol Ihis property lo perform Ihe worY for which application is made and I comply with�he <br /> Slale Cunirar,lore La�v IR.'_7 RCN'and 29G.200 WAC. <br /> � o �� I <br /> . - ,_ — --- - ��l ��-- <br /> � S�gnaturr: - ,��.�����„ i ir .,:;thorizcdA;,ent � ..;; <br /> � <br />