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PEir�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR[ET, EVERETT,WA 98201 <br /> 425•257-8810- FAX 425-257-8857-www•everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 D.M TO 4 PM �� �/Q`'/D <br /> SITE ADDRESS -' � PARCEL TAl(I.D.# PERMIT# <br /> "�_C�'�� l.� � ''-��� l�J o � �\ol o- 02 y <br /> LEGAL LOT N0. BLOCK � TRACT OR SUBDIVISI�N k <br /> DGSC. <br /> OWNER ADDRESS CITVIZIP PHONE <br /> �,��F`/N<_, _ <br /> CpNTACT FOR PERMIT PHONE <br /> TENANTNAME � ����_� ��� - �)-�t� <br /> I�UL ' N�;,. � �=7 ,C%i1-C'.��/' J�/ EdAAIL <br /> I <br /> ����,/�,r • �'� <br /> CONTR.LICENS�E p <br /> i USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �� � i,� � /IF.L l�-�� � _Eledric _-Gas_Othcr J�('<'�' <br /> WORK OESCRIPTION <br /> � /C:<�.L �-Jc'/� �tit � � lJ� - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. I TYPE OF PIXTURE OR ITEM <br /> � Toilel — --�---�--—�----�--- _ aC - air handliny units <br /> � �alhlub __ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> '� �� � Ki�chen sink 8 dispusal _ Gas�ireplaco <br /> Dishwaslier _ Gas ranc�o <br /> Cblhes washer _ Clo�hes drver <br /> � �� Walcn c�a�rr _ Range Iwod <br /> '� SinV.(servicelbadmo{Ne�cJ __ Ezhaust lan <br /> ! -- Heal pump I <br /> f3ackllu�v prevrntcr -- <br /> Urinal _ Unil hcaler <br /> Drinking PouN,un _ Boiler <br /> Floor drain _ Refrigoration <br /> , Grease Irap __ Woods�ove <br /> � � Rool drains _ Olher <br /> _ Olher--_ __--_ _ .. <br /> I — -- . _ . . _ -- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriu�y that I have reod and examined this applicalion and know tho same to be Irue and correcl All provisions of laws and <br /> ordinaces yoverniny ihis lype of work will be complied with whethor spocilied herein or noL The granling ol a permit does nol presume <br /> ito give aulhority to violate or cancel Ihe provision ol any other stalo or local law regulating construclion or the podormance of <br /> construclion. That I am authorized by�he owner of�his property�o perlorm�he work for which applicalion is made and 1 comply wilh Ihe I <br /> I Statc�Contrar,lors Law 18.27 RCW a�d '196.200 WAC. , <br /> �I ��� t�-�t� ����-n-.�if, /0�� �J �Ll � <br /> �i ��naWre ol OvmedConlraclorlAuthorized Agenl ���e �� <br /> � <br /> '� ._. . __--- �- - ----... ----------- - - . <br />