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PrRMIT APPLICATI(�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 G 9� ' �7 <br /> SITE ADORESS PARCEL TAX I.D.N PERMIT N <br /> � � � i.„'�� _,. � L'� f'e il � ��� <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION K <br /> DESC. <br /> OWNER ADDRESS CITV2IP PHONE <br /> " p / .-i�; �-�!'.'�1 � 17Z'� - 7�'� ' ''�i��/ <br /> I r . / ' �) V/ /� I <br /> TENANT NAME I CONTACT fOR PERMIT PHONE i�z � . 7�p/ - 13�9 <br /> ` ��1 .�fr.r/" � E-MAILrO�S CLKP �YH�tCo• CJ <br /> , 1 i i b(1 ni�e�r: <br /> CONTR.LIGENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> '. ,��„ �J, ,,,,� , �. , I ��' Electric _Gas_Ulhor <br /> WORK DESCRIPTION <br /> _ ..,;rG,�r� ::�..,...�.� - ..,,,, �� �.,, _ <br /> �� ��. <br /> PLUMBING MECfIANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air hanAling unils <br /> T Balhlub � Forced air syst�ms <br /> �_ Lavalory(wash basin) 1 Gas piping <br /> � Shower � Wator hoalor <br /> �_ Ki(chen sink 8 dis��osai � Gas liroplaco <br /> �__ Dishwashor Gas ranqe <br /> Clolhes washer � Clolhos dryer <br /> +_ Wator hoaler �_ Range hood <br /> � Sink(sorvlceNadmop/olc.) �__ Exhaust lan <br /> T_ Back(low preventer � Heal pump <br /> Urinal Unit healer <br /> ;___ Drinking Fountain ' Bofler <br /> Floor drain Relrigeration <br /> ;_ Groase trap Woodslove <br /> Rool drains Olher <br /> Other <br /> :— — — <br /> a— — <br /> � <br /> CIiV OF EVERETT LOCAL 8ALES TAX CODE IS J106 <br /> I heroby cedti(y Ihat I havo read and examinad this application and know lhe samo to be trua and correcL All provlsions of lawa and <br /> ordinacos governing Ihis lype ol work will be r,ompliod with whelher specified herein or nol.The granling ol a permit does nol presume <br /> to give aidhorily to violat�or cancel the provision ol a�y olhor state or local law regulaling conslruclion or the perlormance ol <br /> construclion. That I am aulhorized by tho owner ol Ihis property to pedorm Ihe work for which applicnlion is made end I comply with the <br /> Stale Contr2ctors Law 1827 RCW and 296200 WAC. <br /> �y �, �, ;�'�� ;� <br /> �� ' -�. , �� � <br />� Signaturo o(OwnodConlraclorlAuthorized Agenl Dale <br />