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( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org 1 Z � 6-/U <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM W R�D� Z ,..00 Z <br /> �SITE ADDRESS - PARCEL TAX I.D.M PER T N <br /> � / <br /> Q. <br /> LEGAL LOT NO. B OCN TRACT OR SUBDIVISION N <br /> DESC. <br /> ONMF.R ADDRESS CITYIZIP PHONE <br /> � � �r1"�/�"arv Trl nso�� �ti ia E�a�s�„a Rl% , ��o- - — <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E•MNL __ <br /> CONTR.LICENSE M /�Q / ��j,t �/kQ�_y Tc rD�/7 S�I7 <br /> �1 V <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas_Other <br /> WORK DESCRIPTION <br /> ��L'� �Qce �� ory': ON i�l��' sic�E oj- �io4sc. .� !-N,p �Qc �' c�l- hC��ai�i a Jc�is7� <br /> d- l-P`�qIV' 4 Scc�iop rs -f'�no /� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE Of FIXTURE OR ITEM <br /> Toilet AIC—elr handling units <br /> Bathtub _ Forcad eir syslems <br /> Levatory(wash basln) _ Gea piping <br /> Shower _ Water hoater <br /> Kilchen sink&disposal _ Gas fueplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clolhes dryer <br /> Waler hee�er _ Renge hood <br /> Sink(servicelber�mopletc.) _ Ezhaust fan <br /> Beckllow preventer _ Heat pump <br /> Urinel _ Unit heater <br /> _ Drinking Fountain _ Boilor <br /> Floordrain __ Reingerelion <br /> Grease trap _ Woodatave <br /> Rool drains _ Other <br /> Other _ — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5106 <br /> I hereby ceAily that I have read end eMamined this application and know lhe same to be true and correct. All provlsions of lews end <br /> ordinances governing this type oi work will be complied with whether specified hoieln or not. The granting ol a pertnit doee nol presume <br /> to give euthority to v.�ate or cancel the provision oi any other state or local lew regula!ing wnelruction or lhe performance o1 <br /> construction That 1 am authorized by the owner ol lhis property lo perform Ihe work for whlch epplication is mede and I wmply wilh Ihe <br /> Stale Contraclors Lew 18.27 RCW nnd 298200 WAC. <br /> SignaWre of OwnedCoNractoNAuthorized Agent Date <br />