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� � <br /> PERMIT APPLICATION � � Z -� ' <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 8 AM TO 4 PM � - a —D 9 <br /> SITE ADDRESS PA7CEL TAl(I.D.#� PERMIT it <br /> � 0 2 G�3Y.�,�� . l 71�02?oo p - � <br /> ESC. �7?NO z2 BLOCQK TR_ AC�T OR SUBDIVISIO�1 N, � <br /> G %J ~ !O G� �'� <br /> OWNER I ADDRESS CITY2IP PHONE <br /> �ob$4a� �alcl'Q� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> V✓_ „C����G c ���/J� D��CI _ ( E.MAIL �as yya `Y�GC� <br /> Z`3ATRA�Tb � / S c T�f P <br /> � �W h"-�/ <br /> � CONTH.LICENSE M <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> (��'�ZGI�c L C�-�G� _Eleclric _Gas_Other � �Y} !G p�J-U• Q o <br /> "l I <br /> WORK DESCRIPTION <br /> �►� �� • � '1�N�' ►M .t��µt� it� � �C t�1�11�1� <br /> ?�3��o � �lL�►�b <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet NC-air handling units <br /> 8alhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Cl;,lhes w3sher Clathes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust lan <br /> Backflow preventer Heat pump <br />� _ Urinal Unit heater <br /> _ Orinking Fountain Boiler <br /> __ Floor drain Relric�eration <br /> _ Grease irap Woodsrove <br /> Roo(drains Other I <br /> Other ' <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined Ihis application and know Uie same to be true and correct. All provisions of laws and i <br /> ordinaces governing this type of work will be complied with whether specilied herein or nol. The granting of a permil does not presume I <br /> to yive au�horiry t violate or cancel the provision of any other slate or local law regulating constmction or the pedormance ol � <br /> construction.Th I am ull� rized by Ihe owner of this property�o pedorm Ihe work lor which application is made and I compty with the <br /> State Contra ror Law 82 RCW and 296.200 WAC. <br /> ,� � 6��°�� � <br /> Signature of /C t clor/Authorized Agent Date <br /> �� <br />