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PcRMIT APPLICATIuN <br /> CITY OF EVERETT PERMIT SE�tVICES <br /> 3200 CEDAR STREET, FVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �j `I b`p� <br /> SITE ADDRESS �S � y PARCEL TAX I D.# I PERMIT# <br /> ��o, �N , � /I � /v�' �i� I�(�S U ���1 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBUIVISION H <br /> DESC. <br /> OWNER ADORESS CITV2IP PHONE <br /> I ;T;� r i N l, <br /> TENANT NAME CONTACT FOR PERMIT PHON <br /> /� �7 � yz.�-, ��-?�-� �� <br /> 1��1 � � �� �T�W� Y�12.�I1�/ E-MAIL <br /> '�75F <br /> A <br /> (,/'r�`; ���r� ;�� ���, �oi�;,- <br /> CONTR.LICENSE p <br /> USE OF BUILDING IIEAT SOURCE I CON7RACT PRICE OF WORK <br /> T��iL � Il�r'�R- C-� _Eloctric _Cas_Other /S`)/ ��l(1 <br /> / <br /> WORK DESCRIPTION <br /> (;UN S 1'�- ✓c r Tv 0 L S��'�'� `f 1 '?� � <br /> PLUMBING MECIiANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Tollet A/C-air handling units <br /> Balhtub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower W ater healer <br /> Kilchon sink 8 disposal _ Gas fireplaco <br /> Dishwasher Gas range <br /> Clolhes washer Cblhes dryar <br /> Water heater Rango hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> Backllow prevenler Heal pump <br /> ;Irinal Unil hoalor <br /> Drinking Fountain Boilar <br /> Floor drain Roldgeration <br /> _ Groaso Irap Woodsrove � <br /> N — Rool drains --- � Othor — <br /> Olher <br /> CITV OF EVERETT LOCAL 3ALE5 TAX CODE IS 7105 <br /> I horeby coritily Ihat I have read and ezamined Ihis application and know Iho same lo he Irue and correct. All provisions o(laws and <br /> c•dinaces govr.rniny Ihis typo ol work will bo cumplieA wilh whether spocilied heroin or nol.The granlinQ of a permil does nol presume <br /> to give authorily lo violate or cancel the provis�on of any olher stato or local law regulatinc� consWclion or Ihe performancn of <br /> construclion. That I am aulhorized by the owner of this propoAy to portorm Iho work for which application is made and I comply with Ihe <br /> S�p Conlraclors L w 1 .27 RC�and 296.200 WAC. <br /> �-, r,._ ,l ��/��"� " � 5��� G�' <br /> Signalure ol OwnedContractodAuthorizod A9ent Date <br /> y <br />