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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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SI7E ADDRESS ����(� � '' PARCEL TAl(I.D.# — PE IT I! � <br /> � �'�� <br /> „ r{ �'1 C� R j i•✓�+ /:_ -� <br /> LEGAL / LOT NO. BLOCK TRACT OR SUBOIVISION M <br /> DESC. <br /> OWNER ADORESS CITYIZIP PHONE <br /> ��<_�-I!l(;i <br /> TENANT NAME CONTA:'FOR PERMIT PMONE <br /> �. ��,, . ��� - <�y y <br /> �n'�.;-!rI/�� "/j �C �� / /v`• lCI E�MAIL <br /> �� <br /> �..�/�^f ��F.-/'.�.; �i,� C.�i+�s T�, 9/Zs_ /�.G f �i.s ' S�r-1Tl.C- �)�'/o�' <br /> CONTR.LICENSE A �7 Q <br /> ���L�� /�•?�--� / �Z� <br /> USE OF BUILDING fiEAT SOURCE CONTRACT PRICE OF WORK <br /> . <br /> �' Elechic Gas Olher I /� t� C�n <br /> {-����� (�(� 1� (,l<<,rDR-- — — — _ �-- <br /> WORK DESCRIPTION <br /> �/'!; i/�- �_<'_ /1')F 7�itL_ �';��AS1 / ;�n/�F- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilet ___ A/C- air handling uni�s <br /> — A�����i��� _ Forced air syslems <br /> Lavalory (wash basin� ,_ Gas piping <br /> Shr:^r _ Walerhoaler <br /> Kilchen smk &disposal __ Gas Iirepiace <br /> Dishwasher __ Gasrange <br /> Clolhes washer __ Clothes dryer <br /> Walr.r heater _ Range hooA <br /> Sink(service/badmoplelc.) __ Exhaust tan <br /> Backllow prevrntor _ Heal pump <br /> Urinal __ Unit heater <br /> Drinhing FouNain __ Boiler <br /> Floor drain __ Re(rigeration <br /> J Greaso irap _ Woodslove <br /> Rool drains Olhet <br /> -- _. <br /> _ Olher------_. ..---- — — <br /> i <br /> I CITY OF F.VERETT LOCAL SALES TAX CODE IS]705 <br /> i <br /> � ____— <br /> I hereby cmitify Ihat I have reaA and ezamined Ihis applicalion and V.now�he same to be�rue and correcl. All provisions of laws and <br /> ordinaces 9uvemin�lhis type ol work will be complied wilh whelher speciliod herein or nol.The granting of a permil does not presume <br /> Ito givc aulhority to viola�e or r,ancel lhe provision o(any other stale or local law regulating conslruclion or iho parformanco of <br /> construction. Thal I am authorized by the owner of this property to perform Ihe work lor which application is made and I comply wilh the <br /> I Stale_C�nlractors Law 1 27 RCW and 56.200 WAC.� <br /> i� n ._ ���., '� � � :' l �: t� � <br /> Sig alure ul OwnedConlrectorlAulhorized Agent Dale — -- � I y —� <br />