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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 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.H <br /> pFRMITp <br /> �� r � �� �� - I ��-�: e,,� ,c��. -;,�r� <br /> I LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONE ��S <br /> ��,Ot l�IIC; �,��P_`�%Ft�k�/'.� �ll����'�'YFl1��A�;� ��ue �ff,�JJn.�3?.�r-��(�! <br /> TENANTNAME CONTACTF RPERMIT PHUNE / � // <br /> v-+ I <br /> ���t �r�i� (Q.k�-�ff�� �S-`_�.G� —lypy <br /> CONTRACTOR AUORESS CITY2IP PHONE <br /> CONTR.LICENSE p <br /> l �p�_.��_)-` --� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �[leclric _Gas_O�hor _ <br /> WORN DESCRIPTION I <br /> � <br /> � <br /> �,. � _ <br /> --- ri i iMmNr, MECHANICAL <br /> NO. �'.� NO. TYPE OF FIRTURE OR ITEM <br /> Toilol � A/C-air handling units <br /> �alhtub Forced air systems <br /> Lavatory(wash b,��.��u _ Gas piping <br /> Showor Wator hoalor <br /> Kilchen sink 8 disposa� _ Gas firoplaco <br /> Dishwashor ._ Gasrango <br /> Clothes washcr Clolhes dryor <br /> Walon c�ator Ranya hood <br /> Sink (sorvice/badmop/cic.) _ Ezhaust fan <br /> Dackllow prevenlor _ Heal pump <br /> Urinal Unil heatar <br /> Drinking Founlain _ Boiler <br /> Floor drain Refdgeratlon <br /> Groasu irap _ Woodstove <br /> Roof drains Other <br /> Olhor - <br /> — — ---- I _ _ I <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 7105 <br /> I horol�y coritify that I have read and examinod this application and know the same to 6e lrue and correcl. All pravislons of laws end <br /> ordinacos govuming ihis typo ol work will be compliod wilh whethar spacified herein or noL The granting ol a permil does not presumo <br /> lo givo aulhority to violato or cancel tha j�rovision of any othar sfato or local law regulaGng conslructlon or lhe peAormance of <br /> construclion. That I am aulhoriz d by ihd owner o(this proparty lo peAorm the vrork for whlch application is madn and I comply with Ihe <br /> Stato CoNractors Law'i8. R W and .6.200 WAC. f <br /> � � � ' ; ��� �� - �> ;�.��� �/�1-�� <br /> ISignalure of Owner/Conlraclor/Au�h i od Agoro� ' Date <br /> I . .. . _ —�--- — - <br />