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PtRMIT APPLICATI��� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED PROM 8 AM TO 4 PM Q'� -� <br /> SITE ADDRESS PARCEL TAX I.D. p <br /> LEGAL LOT N0. BLOCK TRACT OR SUdDIVISION p <br /> DESC. <br /> OWNER AD�RESS CITYIZIP PHONE <br /> TENANT NAME ��tMidl�s I CONTACi FOR PERMIT j I/��ONE =Q � <br /> - •.�r.�,..-.—� � <br /> �����(� M�RA�6��� E-MAIL <br /> L`Ti'YIP1��RbRE-- <br /> UA� <br /> CONTR.LICENSE N <br /> c�L-rLMrk�ltobl�g� �ds��E S`itsy,�'1 pR-• <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Y�� ����.,' _Electric �Gas_Other .L <br /> �.. <br /> WORK DESCRIPTION <br /> I.LF� �.*,��yp 1� AUL <br /> PLUM ING MECHANICAL <br /> NO. TYPE OF fl%7URE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C -air handling unils <br /> Balhtub Forced air sys�ems <br /> Lava�ory (wash 1>asin) Gas piping <br /> Shower � Wator heater <br /> Kilchen sink 8 dis��osal _ Gas firoplaco <br /> Uishwasher Gasranc�e <br /> Clothes washer Clothos dryer <br /> � Walor hoater Ranc�e hood <br /> Sink(s�rvice/barlmop/etcJ � Exhaust lan <br /> Backllow provenlor Noal pump <br /> I Urinal Unil hoa�ar <br /> Drinkinq Fountain Boilor <br /> � Floor drain Refrigeralion <br /> Grcase lrap Woodslovo <br /> Roof drains Other <br /> _ Olhor <br /> CITY OF EVERETT LOCAL SALES TfV(CODE IS J105 <br /> I hereby cerilify ihat I havo read and oxamined Ihis appliwlion and know tho samo to be true and correct. All provisions of laws and <br /> ordinaces yovorniny lhis typo of work will bo compliod wilh whelher spocified heroin or nol The granling of a permi!doos nol presume <br /> l0 9ive auUioriry to � lale or canr,el tho provisi�.i of any olher stale or local law re�ulaling construction or the performanco of <br /> consiruclion. T , am au orizecl by the owner o(ihis proporty lo pedorm Iha work lor which applicalion is made and I comply wilb Ihe <br /> Slate Contr� 1 s La�v RCW and 2Jfi.200 WAC. <br /> ' Zt 0!' <br /> Si un�of nerl ulhorizod Agenl Date <br />