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P`RMIT APPLICATII�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 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 /> SITE ADDRESS `� PARCEL TAX I.D.N PERMIT N <br /> 3�3 w , c�}S /n/� � F�o 70 - <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> Q��I l�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE'm� ��/ �7�2��/ <br /> � ��j •r� v <br /> �O�� N G `"�`� N�� E�MAIL <br /> G�n-E�-�c- <br /> CONT�LIC�NS�N��J^ ,����Z <br /> lli �ZS <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ����, _Elnctric _Gas_Other / �� Q�(1 <br /> WORK DESCRIPTION <br /> 'n/L�-y �S 5(S�-T+NG /�I�N�V�rioN <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet WC—air handling units <br /> Bathlub Forced eir syslems <br /> Lavaiory(wash basin) _ Gas piping <br /> Shower W�31ar hoalor <br /> Kilchen sink&disposal _ Gas(ireplace <br /> Uishwashor Gas range <br /> Clothes washer Clothes dryer <br /> Wator hoalor Range hood <br /> Sink(sorvice/badmop/olc.) _ E�.hausl fan <br /> Bzckflow prevenler _ Hnat pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boller <br /> Floor drain R�frigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Olh�r <br /> CITY Of EVERETT LOCAL SALES TNC CODE IS�105 <br /> I hereby cerilify Ihal I havo road and oxamined Ihis application and know the same to be lrue and correct. AII provisions ol laws and <br /> ordinaces governing this typo of work will be complied with whelhor specified herein or nol.The granting ot a permil does nol presume <br /> l0 9ive aulhorily lo violale or cancel tho provision of any other stale or local law regulaqng construcQon or lhe pedormance o( <br /> conslruction. That I am au�horized by the owner of this property to poAorm tho work for which appllcalion Is made and I comply with lhe <br /> Slate 'oNractors Law 18.27 RCW an 296.20U WAC. <br /> �� ���-� �/s � <br /> nature of O��nedConlractodAuthorized Agenl Dat� e — �� <br /> L <br />