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PcRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES `'1•' :�� `� <br /> 3200 CEDAR STREET, EVERETT.WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 1 PM /��J/1� 7 <br /> /�/L�! <br /> SITE ADDRESS • PARCEL TAX I.D.M PERMIT/ <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��/ / <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> i <br /> [ E�NIIVL <br /> Co P�<1� l�� N�«1 �0�0 Q4/c IZa. L.�AN b✓A 98°$� <br /> �Y(7NTR.LICENSE M � L/N / SJ ( �T <br /> � � ,K f �o/iDf/o yas 7y���f � <br /> USE OF BUILDIN HEAT SOURCE CONTRAC7 FRICE OF WORK <br /> pF/�« (�/A,� ���,� _E�e�tr�� �3aB_��ha� S v <br /> WORK DESCR PTION <br /> f')')�c���A��t-P ,��-� T T <br /> �r <br /> PLUMBING MECHANICAL <br /> NO. TVPE Of FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilot A/C-air handling units <br /> Bathlub � Forced alr syslems <br /> Lavalory(wash basin) � Gas pfping <br /> Shower Walor heater <br /> Kitchon sink 8 disposal Gas(ireplace <br /> Dishwaslior Gas rangn <br /> Clolhes washor Clothes dryer <br /> Wntor hr.atcr Range hood <br /> Sink(service/bar/mop/otc.) Ezhaust(an <br /> BackOow proventer Haa1 pump <br /> Urinal Unit healor <br /> Drinking FouNain Boller <br /> Floor drain Relrigerallon <br /> Groasn trap Woodslove <br /> Rool drains Other <br /> Othar <br /> CITY OF EVERETT LOCAL SALES TAI(CODE IS J705 <br /> I hereby ceritily thal I have read and examined ihis applicalion and know the same lo be true end correcl. All provisions ol laws and <br /> ordinaces govorning this typo ol work wi�l be complied with whelher speci(iad herein or not.The granting o(a permil does nol presume <br /> to give aulhmity to violato or cancol the provislon ol any other state or local law regulating construction or lhe peAormance ol <br /> c�nslruction. Thal I am aulhorized by the ownor ol this property lo perlorm lhe work for which applicalion is made and I comply wilh the <br /> State Conlractors Law 18.27 RCW and 296.200 WAC. <br /> �_/ `�� �Y-J9 <br /> Signalure ol wner/ onlrac�oHAulhorized Aganl Dale I� <br /> 2 <br />