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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —wv✓w.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �' � - �� PARCEL TAX I.D.IY ,pERM1T# , / <br /> �� .n����: (.�.� , �/� �. �°'�� � �� <br /> 6 U � ' _ y�l� <br /> LEGA LOT�10. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> 1 <br /> L.-��F i�., � % <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> L; ,� �; I ( � � f- „ )l�' �`�� �y" 5 )��� L1�`�/'/ <br /> .��f 1 /� -•— , .-�:s � <br /> CONTHACT_OR , /} ADDRE55 CITY2IP PHONE '' <br /> ( !%�i� � <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> (Jf � /l.��: —�Elr ' ic ._Gas_Other , I �,n <br /> WORK UESCRII'TION 1 r , <br /> ���� �' � � ! F__ i� l�ic..�-1i_ i� � i�,c) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITF.M <br /> Toilel _ A/C-air handling unils <br /> Balhtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> � Shower _ Waterhea�or <br /> Kilchen sink 8 disposal _ Gas firoplaco <br /> Dishwasher _ Gasran9e <br /> Clolhes washer _ Cblhes dryor <br /> Waler hoaler _ Range hoed <br /> Sink (sorvicolbadmoplelc.) __ _ Exhausl fan <br /> Back(low preventer _ Heal purip <br /> Urinel __ Uni1 healer <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Relrigeration <br /> Greaso irap Woodslove <br /> Roof drains _ Olher <br /> Olhor-- _ <br /> CITY OF EVERETT LOCAL SALES T/V(CODE IS 7105 <br /> I horeby cerilily lhal I have read and oxamined Ihis applicalion and know iho sama�o bo lruo and correcl AII provisions of laws and <br /> ordinaces governing Ihis lypo o(work will be complied with whelhor specified herein or nol The granling of a permil does nol presume <br /> lo pive authorily lo violate or cancel Ihe provision of any olhor sta�e or local law regulaling construction or ihe peAormance of <br /> cons���ction. That I am authorized by the owner ol this property to perlorm t ie wcrk for which appli�ation Is made and I compl� with ihe <br /> Sta;e�(��ntrar,tors Law 18�7 RCW 2n 29G.200 WAC. <br /> � .n ,, ;• f, ,",%�„ '�' j�' �� �(� — <br /> i naturo of OwnedContraclorlAulhorized Agon� a e � <br /> ✓ <br />