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PERMIT APPLICATIdN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32U0 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 /> SITEADDRESS n �C' '��� PARCELTAXI.D.N PERM�N�� _ � � <br /> %r�p� �.V. C' 7��/Pit� �U� <br /> LEGA LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER AUDRESS CITY2IP PHONE <br /> �F� N5 <br /> TENANT NAME f,ONTACT fOR PEHMIT ,� PHONE ��S � <br /> �1��i rJ(.� i�/�//'T �� 1=� ( E)"•'1�T--`��� S�ib"2�"�) <br /> CONzRACTOR ADORESS CITI'21P PHONE <br /> Ijn�;^�C� <br /> CONTR.L�CEN5E M <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��iXL• D OI' t' ir_� ��Fl�'f��+ � � nr' FJ <br /> ��V"i�"�/^ o"!`i�/i �-{I �if�- —Electric _Gas_Other `�� <br /> WORK DESCRIPTION <br /> /.'�_,I/?.c,C (���!', J';il-f l j-- /,',n-r;� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilat _ A/C—air handling units <br /> Balhlub _ Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kilchon sink 8 disposal _ Gas tiraplaco <br /> Dishwashor _ Gasrange <br /> Clolhes washer _ Clolhes dryer <br /> Walor heatcr _ Rango hood <br /> Sink(servico/bar/mop/oic.) _ Ezhausf(an <br /> �ackllow provontor Heat pump <br /> Urinal _ Unil healor <br /> Drinkinc� Founlain _ Bailer <br /> Floor drain __ Refrigeration <br /> Grease trap _ Woodslove <br /> Rool drains _ Other __ <br /> Othar — — <br /> CITY OF EVERETT LOCAL SALES TNC CODE IS J105 <br /> I heroby ceritify Ihat I havo read and examined lhis application and know the same lo be lrue and correct. All provisions of laws and <br /> ordinacos�oveminc�Ihis rypo of work will be complied wilh whethor speciliod heroin or nol.The granting of a pemiil does nol presume <br /> to give aulhority to violato or cancol lho provision ol any olhor stale or local law regulating construclion or the perfortnance of <br /> conslruction.Thal I am authorized by Ihe uwner of Ihis property to pertorm Ihe work tor whlch applicalion is made 2�d I comply with the <br /> Slato�onlractors Law 1B.2 RCW and 296.200 WAC. <br /> , ,/� . _� ��•,,. j�� `f� C�(- <br /> ignaWre of Owner/ ontractor/Aulhonzed Agent Dale �I <br /> 2 <br />