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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM � _ �� �Q � <br /> SITE ADDRESS � PARCEL TAX I.D.q PERMIT ft <br /> zi Z S ,� � S -4-� o o�-cC <br /> LEGAL LOT NO. BLOCH TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE O 'Y S - 9 <br /> �lA��� I�UF�/ YI � r.�� ��[��� ZiZS� Pcv4� Sf Lf���rt: l-�Vl48zo� <br /> 1ENANTNAME � CONTACTFOR PERMIT PHOkE <br /> Q, L,�WF� � <br /> E-MAIL ('e vh U S�.N� <br /> �bATIiA� �6b7FE�� �FFkiFti <br /> CONTR.LICENSE M V1 I� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �E��J _Eleclric _Gas�Olhm <br /> WORK DESCRIPTION <br /> ��- �° � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE Of FIXTURE OR ITEM <br /> _ Toilot A/C-air h�ndlinp unils <br /> _ BathWb Forced air systems <br /> _ Lavalory(wash basin) Gas piping <br /> Shower Waler healor <br /> Kilchon sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothos washor Clolhos dryor <br /> Waler heater Ranqe hood <br /> Sink (scrvicolbadmop/olc.) Exhausl(an <br /> �ackflow preventer Heal pump <br />� Urinal Uni�healer <br /> Drinking Founlain Boller <br /> Floor drain Relrigeration <br /> Greasa trap Woodstova <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I heroby coritify Ihat I hav ea d examinod lhis applicalion and know Ihe same lo be true and correcl All provisions of laws and <br /> ordinaces goveming 1 ' yp work will be complied wilh whelher specilied herein or not The granting o(a pormil does nol presume <br />' lo�ive aulhority to ' ,te r.anr,el Iho provision of any other state or local law regulating construclion or lhe peAormance ol <br /> conslruction. Th� m horimd l y Ihe own�r of lhis property lo peAorm ihe work for which applicalion Is mado and I comply wilh the <br /> Slale Contra� r . A.21 RCW anA 296.200 WAC. <br /> 8 // 20" 0 I <br /> Sign� r. wnedContraclodAulhorizod Apenl Date <br /> ___ _.. . . _. . .._. _ . _..._--- -- -- ----------- -- � <br /> r <br />