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F��RMIT APPLICATILN <br /> CITY OF EVERETT PERMIT SERVICES � '� - � � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDR SS /' � PARCEL TAX I.D.N PE T k <br /> .�L �� �-Gc.t��/ - <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> .�����/� /�i�G✓��t����/ /1�,�/���Z�'�7S �/25�is-q�� <br /> �A�NAM��� I �CT FO�MIT �� PHON����� <br /> / �/, / <br /> �� /7,(�� Uv Ly E�MIAIIL� <br /> �"`/�—�G61SRE �1TYiifF�PADAE� <br /> ��'i�� <br /> CONTR.LI�ENSE 7f <br /> USE OF BUILDING I HEAT SOURCE ONTRACT PRICE OF WORK <br /> �'.1/ <br /> � �U �f,ei _Eleclric�Gas__Othor �-� <br /> WORK DES RIPTION <br /> �,c�.�'Il.f/1'I� `i7"l��"�'�t/c,ml'.�'bs��GU�1�jlM ,. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IT[M NO. TYPE OF FI%TURE OR iTEM <br /> ------------�------------------�- — <br /> Toilet NC -air handling units <br /> � [3alhtub Forr.eJ air syslems <br /> � Lavalory(w.ish b;isin) ---- Gas piping <br /> Shower W aler heater <br /> -= Kitchon sinh 8 disposnl Gas Iirupiaco <br /> Disliwashm Gas ran�e <br /> Clolhes wnshm Clothos dryar <br /> � Waler hoator _ Ranc�o hood <br /> Sink(sorvice/badmoplelc.) Ezhausl lan <br /> �ackllow prevenim Hoat pump <br /> �_ Urinal _ Unil healer <br /> Drinking Pounlain Boiler <br /> � Floor draln _ Rolrigoration <br /> Groase Irap ___ Woodslovo <br /> Rool drains Other <br /> Othar — - <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I horoby corilily thal I have roaJ and examined this application and know tho same lo bo true and cortocl. All provislons ot laws and <br /> ordinaces povorning this lypo ol work will be compliod with whalhor spocifiod herein or not.Tho grenting ol a permit does not presume <br /> �o give authori�y lo violalo or cancel Ihe provision o�any o�hor slato or local law regulating consWction or lho perlomtance of <br /> conslruclion,That lam�nu orizeA by the owner of Ihis properly lo pedorm Iho work lor which applicalion is made and I wmply wilh Ihe <br /> Slato C d � urs aw R�iiG' 00 WAC. <br /> � � <br /> Si a uro ol OwnedConlrectorlAuthorized Ac�ent Date <br />