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) <br /> i <br /> r_ — <br /> � PERMIT APPLICATION <br /> CITY' OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98207 <br /> 425•257-8810-FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AODRESS PARCEL TAX I.D.p i , RMIT p <br /> �- �� � . � ,, � , � � � � , . � � , � , . . � , , ,, � � �U� 7 - .3�1 <br /> LEGAL LOT NO. BLOCN TRACT <br /> DESC. <br /> OWNER ADDRESS GITYIZIP PMONE ,+ , �� � , � � , ; <br /> / ) hl ri� . l.. �i�._ . . � � i `� i � �� , �. i �'I � ri� � i : i.. �� i1 � 1 � <br /> TENANT NAME I CONTACT FOR PERMIT PMONE <br /> � ., r� r�u � � . , � . . f t � � � i i I� i i �.i � i�� � � � .. `�i � , �) . , ) � . <br /> CONTRACiOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE N I ' <br /> USE OF BUILDING H[AT SOURCE I .:ONTRACT PRICE OF WORK <br /> . . � i�i �' i . � � � <br /> / i �� � ,_Electric __Gas_Olhor ,.�YZ.I <br /> WORK DESCRIPTION <br /> � ' . . . i . , � . � , 1 �. . . . r I <br /> 1 i I <br /> � , � ' . . r'. • �� � . . � � �, . ' i . , 1 <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM NO. TYPE OF FI7(TURE OR ITEM <br /> Toilel _ NC-air handling units <br /> Bathtub Foroed air systems <br /> I — Lavalory(wash basin) __� Gas piping <br /> Showcr Waler healer <br /> I __ Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwnshcr Gasrange <br /> � _ Clothos weshor __ Clolhos dryer <br /> Laundry tray _ Ran�e hood <br /> Smk(service/bar/mop/elc.) _ Exhaust fan <br /> Backflow preveNer Heal pump <br /> Urinal Unit heater <br /> Orinking fountain Boiler <br /> Floor drain Reingeralion <br /> Greaso trap _ Woodstove, <br /> Rooldrains Olher_; � � � <br /> _ Othor — - _ � �. � �� ' �.�_ <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 7105 <br /> I hareby ceritdy that I havo rr.ed�nd examined lhis applicalion and know the sama lo he true and correcl. All provisions of�aws antl <br /> ordinaces governing Ihis type of work will bo complied viilh whether specified herein or noL The granling of a peimit does nol presume <br /> lo c�ive aulhority to violate or wncel Iha provision ol any olher state or local law ragulating wnslrudion or tho padormance of <br /> consiruclioa Thal I aM aulhonzed by the ownor ol lhis pmpeAy to perform Ihe work for which application is made and I comply with Ihe <br /> State Conlractors LeW 1027 RCW and 296h00 WAC. <br /> � � I <br /> C � � ' � � � � � : <br /> Signature o Own rl onlractouAulhOnzed Agent ' Dale �1 <br />