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( <br /> PERMIT APPLICATION <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 FROM 8 AM TO 4 PM - - <br /> SITE ADDRESS PARCEL TAX I.D.k PER IT N <br /> �� �� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION k <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME ��b�Ldlt.'� I CONTACT FOR PERMIT %I'�I HONE <br /> �rr T � ` <br /> i�AT 'ti� "[1M�t� G�IS LJ,ti(D e+�a� <br /> L`1T4iif� <br /> UA� <br /> CONTR.LICENSE M <br /> c��.7'twt�k�KoblsRA «t5S l.�Ks ST�ekt�`T��- <br /> USE OF 6UILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��� /����.' _Eloctric �Gas_Olhe� .L <br /> WORK DESCRIPTION <br /> �.LF� � w� M�Iri_ 1� wl.L. <br /> PLUM ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR IiEM <br /> Toilot A/C—air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower � Walorhuater <br /> Kitchon sink&dis{wsal _ Gas(iroplace <br /> Dishwasher Gasrange <br /> Clolhos washer Clolhes dryor <br /> Walor hoator Rango hood <br /> Sink(sorvice/bar/mop/elc.) � Exhausl fan <br /> Backflow provantor _ Heal pump <br /> I Urii�al Unit heater <br /> Drinkin� Fountain Boiler <br /> = Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> O�hor <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I horeby cerilify lhat I ha•re read and oxamined this application and know the same to be true and correcl. All provisions ol laws and <br /> ordinaces goveming Ihis lypo of work will bu compliod wilh whother speci(ied heroin or not.The grantinp of a permil does not presume <br /> to�7ive authoriry to ' lale or cancel the provision of any olher stale or local law re�ulaling construction or Iho peAormanco of <br /> conslruction.T am au orized by lhe owner of this proporty lo peAorm Iho work for which appiication is made and I comply wilh Ihe <br /> S�ale Contr t s Law RCW and 296.20C WAC. <br /> � �' zt �Y <br /> Si ure ol •ned . ulhorized Ac�ent Dale I I y <br />