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I <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 � a `�"7'"U� <br /> SITE ADDRESS � � �,`�� PARCEL TN(I.D.N I P�I v' �� I <br /> 30v3 l.J �ie I` v ,� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> Cc�rn a+�, Sa <br /> TENANTNAM CONTACTFORPERMIT I PHONE <br /> E�MAIL <br /> r� � �� P��.Mb,�� <br /> CONTR.LICENSE M T�y�LI �7lt V'Q 3 N T <br /> � Y <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> _Electnc _Gas_Other � <br /> WORK DESCRIPTION <br /> � � '�YUC�, \��S�ec>1�cNl <br /> `��,1n.v��,���� � C'Gv, �jw' ��-�,� — <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air syslems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water hoaler <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwashar Gasrange <br /> Clothes washer Clothos dryor <br /> � Watar hoater _ Range haod <br /> Sink(sorvico/bar/mop/otc.) _ Exhausl fan <br /> Backllow pravonler _ Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drein Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains Olher <br /> Other — , <br /> CITY OF EVERETT LOCAL 9ALE3 TAX CODE IS J105 <br /> I horeby coritify that I have read and ezaminod Ihis applicalion and know the samo lo be lrue and correcl. All provisions of lawa and <br /> ordinacos governing this type ol work will be compliod willi whelher specified heroin or nol.The granting o(a permil does not prosume <br /> lo givu aulhorily lo violalo or cancel ttio provision of any othor state or local law regulating consfruclion or lhe performance of <br /> constr Sion. That I am author' tl by tho owner ol lhis propeAy lo porlorm the work for which applicalion is made and I wmply with Ihe <br /> Slato qnlractors Law 18 7 and 296.200 WAC. <br /> i <br /> c-- —_ <br /> C�--J — <br /> SignaWre of OwnedConlraclor/ u � ed A�ont Date / � <br /> � <br /> � ----- / ( <br /> 1 <br />