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�— ----- — — - — <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM I� ` � '"�� <br /> SITE ADDRES!i � PARCEL TAX I.D.N PE fAIT# <br /> iO4i �U� c�-s,��� 2� � �n���-��� <br /> LEGA LOT NO. �BLOCK TRACT OR SUBDIVISION M <br /> UESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> r�,�. , ,� �. <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��('��� i�^�� � , ( �Jrl,% �� �rak� E-MAIL <br /> � l'1�RSp--T-- <br /> _._., j <br /> C LICENSE M <br /> USE OF BUILDING �AT SOURCE CONTRACT PRICE OF WORK <br /> �� �i}� (� r �� (G�� Eleclric _Gas_Olher � C�G(1 <br /> WORK DESCRIPTION <br /> l� cc �.�, ��.r� r� �,,��c-�a�'- �3�-D6., <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Tollet _ A/C–air handling units <br /> ��Ihtub _ Forced eir systems <br /> l.evatory(wash besin) _ Gas piping <br /> Shower _ Waler healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> pishwashcr _ Gasrange <br /> Clolhos washer _ Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exheusl fan <br /> BackOow prevenler _ Heatpump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiter <br /> Floor drain _ Re(rigeralion <br /> Grease Irap _ Woodsrove <br /> Root drains Olher _ <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 7106 <br /> 1 hereby certily that I have read end examined this application end know Ihe seme to be true end correct. All provisions o(lews and <br /> ordinances governing this lype ol work will bA complied with whelher specified herein or not. The granting of a parmil does not preaume <br /> to give authorily to violato or cancel the proviaion of eny other sla�e or local law regulating construction or Ihe peAormance of <br /> construction. �lhat I em aulhorized by Ihe owner of Ihis property lo peAorm the work lor which applicatian is mede and I wmply with Ihe <br /> Stat Conlraclors .ew 8,2'RCW a�d 296 200 WAC. / <br /> �v/r,n.n.,� �����1�^.��� C� `L�� � C <br /> ignature of OwnedCoNraclorlAuthorized Agent a�e ( <br /> /Z <br />