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� cRMIT APPLICATIJN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-�57-8857 -www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (� - a-c,� <br /> SITE ADDRESS � 1 'r��� � � PARCEL TAX I.D.f! PERMIT p /��(� <br /> —�"� � a✓ �lj> / ti � ' /'-�� - l/T I <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> '`�V / ;� (' <br /> TENANT NAME COJ�!TACT FOR PERMIT (�PHONE � � l� <br /> �Jr£' I .� �� / J�'��/1 �,ji�/cSk-� f E-MIAIL �I� � c"J .y/ <br /> �— ---- <br /> �/� /1 '1 �'l(>/ r,l^.'„ i�, � �'_`��� <br /> CONTR'.LICENSE N <br /> USE OF BUILDING li[AT SOURCE CONTRACT PRICE OF WORK <br /> ��,�1-i� ��=�-�f•�(�' � _Eloclric _Gas_Othor �i.�1 � 0 0�7 <br /> WORK DESCRIPTION <br /> �'� r � '��S /`I�/`-. <br /> [ :�f1�; r�'-� �,- ; /�'`���/ �C i/� �, � -/1.� f'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TVPE OF FI%TURE OR ITEM <br /> Toilel A/C-alr handling unils <br /> Balhtul� Forced air systnms <br /> Lavatory(wash basin) Gas piping <br /> Shower Wator hoalcr <br /> Kitchen sink 8 disposal Gas�iroplaco <br /> Dishwashcr Gas ranyo <br /> Clolhes washer Clothes dryFr <br /> Water hoator Rango hood <br /> Sink(servico/bar/mopletc.) Exhaust lan <br /> Oackilow prevontor Heat pump <br /> Urinal Unit healer <br /> Drinkln�Founlain Boilar <br /> Floor diain _ Relrigaration <br /> Grease���p Woodslove <br /> Ro�(drains Olher <br /> -- Olnar — — <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS�705 <br /> I hereby c�ritity Ihal I have read anA examineA ihis applir.ation and know iho same to be irue and correct. All provisions of laws and <br /> ordinacos goveminc�Ihis type ol work will be complied with whelher specifiod herein or not.Tha granling of a permit doas not presume <br /> to give aulhorily to vlolate or cancel lhe provision ol any oth�r stale or local law regulating consWction or Ihe perlortnance ol <br /> conslruclion. That I am aulhorized by Ihe owner of this property to portorm lho work for which applica�ion is mada and I comply with the <br /> S�ate7Contradors�awl827 RCW�nd 29fi200 WAC. ^ j <br /> ��1�)ni� r.� �� , ��.+ -�V i, i �� ��f. <br /> . � Y <br /> Siynature of OwnedContrac�otlAuOiorized Ac�ent � Date �/L <br /> ( <br />