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PERMIT APPLICATION ' <br /> CITY OF EVERETT PERMIT SERVICES i <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.p P�jR�MIT N <br /> ��� � �� � �l. � •�� � U`J;�I��L/ l�`7��� // ' '/ i � <br /> l fGAI. LOT NO. BLOCK TRACT � <br /> Df SC <br /> OWNER ADDRESS CITV2IP PHONE <br /> �?Ol�17��0 /��(���`�f _ �G1.1'►�Q� _ I <br /> � TENANT NAME CONTACT FOR PERMIT PMONE <br /> '� s��.a��.e. J���A��... C��.� 3�� -�35—� ��� <br /> � CONTRACTOR � w i,�� . Y/�r, ( D��i/i S AD�ESS �,��A`l ����n'�ZIP PHONE I <br /> f�b�..�V' �jt ��. i �ulu C/ L -3 <br /> /��`'� ( tC� /�/�� ,/� �}�7 ] 'J1 3�0 -�3�- I�l� <br /> � CONTR. LICENSE M l,�,UL/V LJW�-✓ 1 / �� " I� 'l�'II(,1 G� tZ�L� �(0 00✓ ___ I ,.. <br /> I <br /> USE OF BU/ILDING HEAT S RCE CONI'RACT PRICE OF WORK I <br /> S f Y� I _Electnc A Gas Other ���� f I I <br /> � . ✓ <br /> WORK DESCRIPTION ii <br /> a1�S�a�-Q- ���13 -f�. ry�ce, '�, <br /> � d- r��c� w�V' � I� <br /> I PLUMBING MECHANICAL ' <br /> I NO. TVPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM ��.. <br /> ��, Totlet NC-eir handling units I <br /> � Balh�ub � Forced air systems I. <br /> �. Lavatory(wash basin� � Gas pipiny ! <br /> Showe� Water hea�er i <br /> �� Kdchen s�nk R disposetl Gas fireolace �i <br /> �'I D�shwasher Gasrange �I <br /> � Clothes washer Clothes dryer <br /> � Laundry tray Rangehood II <br /> Sink(servir.elbarlmop�etc I Exhaust fan <br /> Backllow preventr,r Heal pump ,. <br /> '�. Urinal Unit heater ! <br /> �� prinking Fountain Boilm '�.. <br /> '. Floor drain RefngeraUon ��.. <br /> Grease Irnp Woodslovn . <br /> � Rool drams Other .. . . ... '�.. <br /> � Olher . . �� <br /> �I CITY Of EVERETT LOCAI SALES TAX CODE IS]105 , <br /> I heieby ce�ilily thal I have rQad and ezemined Ihis apphcation and know Ihe same�o be irue and correcl. All provisions ol laws and ' <br /> ordinaces goveminy ihis type of work will be comphed with whelher speciGed herein or not The yranling ol a permil does not presume <br /> lo ,yive nulhority lo violale o� r.ancol�he provis�on of any olher s�ate or lucal law regwating constnic6on or Ihe pe�lormance ol <br /> cnns��uchon That I am aulhonznd by Ihe owner o�Ihis propeAy to pr.rlorm the work lor which applicahon�s made and I comply wilh Ihe <br /> ! Sta�e 'onlractors L�w 1P 7 RCW and'196200 WAG ,j <br /> � � o U � 6 � <br /> �� Siyn ure of Ownur/Con rar.torrAuthonzed Agent Date <br />