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-------- --- ------ ; — <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 99201 <br /> 42�257-8810-FAX 425-257-8857-www.everettwa.org <br /> / �; , , APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> PARCEL TAX I.D.# PERMIT N <br /> SITE ADDRESS _ � � I <br /> 3 �,5' i b � <br /> LEGAL LOT� �, BLOCK TRACT <br /> DESC �� CITYIZIP PMONE <br /> OWNER ADDRESS <br /> TEN�(�� � � /y; 0 ' �� n�ri�i�S S��j[��zl' � <br /> NT���I^�— CONTACT FOR PERMIT PMONE <br /> � �PUP� ��,� .tn-��P � J�S 3 " �`/"�'/`/'! <br /> � � Tv CITYIZIP PHONE <br /> CONTRACTO �/ AODRESS �,�J f�57-�S�I' �' <br /> �C_L<� �i�iY e�-.r���Sk�MC �f .K N�r�i-aI 6�/C �8��2� i�" 3I' <br /> CONTR.LICENSE Rtl <br /> '!�G'�' � ���� �� CONTRACT PRICE OF WORK <br /> USE OF BUILDIN6 HEAT SOURCE � <br /> ' Electnc _Gas Criher (]� ��/�Cb��j _ <br /> CNc, ) S�P �i-Pn — L— <br /> WORK DESCRIPTION <br /> � �/LG' u.� � /��'t `� <br /> . ,l na�i ,� - Jr C. <br /> �� MECHANICk <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR�TEM <br /> --- AJC -air handhng units <br /> Toile� Forced atr systems <br /> BatMub Gas piping <br /> � Lava�ory(wash basm) — Water heater <br /> _ Shower Gas fueplacc <br /> Kdchen sink 8 disposal — Gas range <br /> Dishwasher Clothes dryer <br /> Cbthes washer '— Range hood <br /> Laundry tray Exhausl lan <br /> � � Sink(servicelbadmop/elc � _ Heat pump <br /> _ Backllow preventer UNt heater <br /> Urinal Boiler <br /> _ Dnnking PouNain — Rr,fngereUon <br /> Floor drain — Woodstove <br /> Grease trap O�her _ <br /> Rooldrams � '—' <br /> � otne� G " f' ,a2s��� — _ <br /> -- - - I <br /> I - — -- <br /> -- ---- <br /> - --- <br /> � CITY OF EVEREiT LOCAL SALES TAX CODE IS 0106 �' <br /> I hereby cerddy ihat I have read and e■ammed lhis apphca6on and know the same lo be irue and corred All provisions of laws and <br /> ordinaces govaming ihis type ol work will be compGed with vfiether speciheA herein or not The granUng of a permit does not D�esume <br /> to grve authonty to vrolate or cancel lhe proviswn of any other state or local law regulaUng construction or the periormaace of <br /> construchon That I am authorized by the owner ol ihis property to perform the woik for which ap�licatwn is made and I comply wilh lhe <br /> State Contrac�ors Law 78 27 RCW and 296 200 WAC <br /> ISignature of OwnedConiractodAuthonzed Agent �ate <br /> I __—�-- ------------- <br /> I _ _ . ._.-- -�-�-- -._. - - <br />