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1- cRMIT APPLICAT'�JN � <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 T04 PM �j _��� <br /> SITE ADDRESS �'n � '���� PARCEL TAX I.D.# PERMIT p <br /> ��.�3 (�v, GP> „��, ti,� Z� -0`13 <br /> LEGAL LO?NO. BLOCK TRACT OR SUBDIVISION M <br /> OESC. <br /> OWNERR AOORESS CITYI2IP PHONE <br /> 1 l���� ��� � <br /> TENANT NAME I CONTACT FOR PERMIT PHO <br /> � � i ��'1,� � �lb- �G�J �� <br /> �'� �'� I ��' � j',Z 1'�`i f�fr.� e�Mni� <br /> ��— — <br /> �!� f-1// 1�1f=u.�, � ��•� r,:,r' :r <br /> CdNTR.UCENSE p <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRIGE OF WORK <br /> �, <br /> �,� ��,j� ����,pJ ��,� _Eloctric _Gas Olher ' !��i �i �,,) <br /> WORK DESCRIPTION <br /> _,N�:,;�.ri,- . N�w rL,1�i ►%�r�r��: <br /> �- - <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilr.l A/C-air handl�ng unils <br /> BathWb Faroed air syslems <br /> lavalnry(wash basin) Gas piping <br /> Shower Wator heater <br /> Kilclien sink 8 dis{wsal Gas firoplace <br /> Dishwashcr Gasrange <br /> Clothes washer Clothos dryer <br /> Wator hoaler Range hood <br /> Sink(servicr./l�arlmop/cta) Exhaust(an <br /> Back(low prevonter _ Heat pump <br /> Urinal Unil hoalar <br /> Drinking Founlain Boller <br /> Floor drain Refiigaralion <br /> Groase lrep Woodstovo <br /> Roo(drains O�he� <br /> Clther <br /> CITY Of EVERETI LOCAL SALES TAX CODE IS 7105 <br /> I hemby ceritdy Ihat I have read and ezamined lhis applicalion and know the same lo bo Irue and corroct. All provlsions ol laws and <br /> ordinaces c�overning Ihis lype ol work will bo complied wilh whether speci(iod herein or rot.Tha granling of a permil does nol presurne <br /> to givo au0iori�y lo violate or cancr.l Ihe provision of any olher slato or local law regula�ing consWction or the peAormance of <br /> conslruclion. Thal I am�ulhorized by Ihe owner ol lhis property�o pedorm Ihe wurk for whlch applicalion is made and I comply wilh lhe <br /> Stale G�������clors Law 18.27 RCW nd 2�3�.200 WAC. <br /> � / <br /> �,.,t/ . : , ,. , � �, ,,�i.,^ ,/ , �/ � n� <br /> Si'cJnature of OwnedContraclodAulhorized Agenl Date ,�/ <br /> ( _ ___ -- --------- --- L <br />