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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STREET, EV[RETT, WA 98201 <br /> A�125-257-8810-FAX 425-257-8857 -www.everettwa.org <br /> �S�b S �"" APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �—� —1 O <br /> SITE ADDRE55 n PARCEL TAX I.D.N ( PERMI7# <br /> - -- ��------ --�t�� 1,�� "' l�-J <br /> LEGAL LUT NO. BLOCK TRACT OR SUBDIVISION N <br /> Uf:SC, — �---_ <br /> 1 <br /> OWNER � ADDR[SS CITV/ZIP PHONE <br /> TENA� _�_��l�u--- l'1�l?� z ���.�� _ ��' ��� -- <br /> E ///� CONTACT FOR PERMIT � PHONE� <br /> I�y!�-�1� / !� I Y� � YL � —.< S � � f/' I/�MA� <br /> - C�NTRACT�—��"— — - ADDR —L`I Y�Y�I i�—�----�-- <br /> CONTR.UC[NS���� <br /> USE OF BUILDING I — � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /�� � 1 Irr.tric Gas O�her <br /> - -----...— ------------- ---------------- <br /> WORK D[SCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF FI%TURE OR IT[M NO. TYPE OF FIXTURE OR ITEM <br /> _—. —.—_—___.—__—_—_._—___— __ <br /> Toilet �/C-air handling units <br /> f3alhtub Forced air systems <br /> __ I.av�dory(wash basin) --- Gas piping <br /> Shower Water hea�er <br /> ___ Kilchen sink &Jisposal __ Gas lireplace <br /> Dishwasher __ Gas rangc <br /> Clolheswasher __ Clothesdryer <br /> � Waler he�ter __ Ran9e hood <br /> . , Sink (scrvicc/badmo�ilcic.) __ cxhaust f,in <br /> . [3ack11ow preventer -_- Ifea�pump <br /> Urin,il Unil hcater <br /> __ Drinkiny I-ounl.iin _ Uoilcr <br /> __ 1=1oor diain ___ Refrigeralion <br /> __ Greaselrap _ Woodstove <br /> Roo(drains Olher <br /> — Olher <br /> ..--- ------------- ---- ----- ------ --- <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 71U5 <br /> I hereby ceihfy that I have read and examined this applica�ion and know Iho sai ie to bo Irue and wrrect. All provisions oi laws and <br /> ordinances�overniny Ihis type of woik tvill be complied wdh whe�her specified herein or not. lhe granling o(a permit does nol presume <br /> to yive :mihon�y lo viclate or cancel Ihe provisiun of any other slate or local law rzgulating conslruction or Ihe performance of <br /> conshuction. I hal I�q�u thorized by the owner ol�his properly to pertorm�he work ffJor which application is mado and I comply with Ihe <br /> Slatc Conlraclors L�<v 1/ 271 CW ond 29U200 WAC.-- - / � <br /> 0 �� ��L� 9 ) � / J <br /> 1__ <br /> Si nature of Own�r Conlrac or/nuthorir.e A ent fUa <br />