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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —wvuw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM i � � �� ,_,b� <br /> SITE ADDRESS Sli�� �� PARCEL TAX I.D.N PERMIT p <br /> ,�,�?9/ LoC/J F A�-� '' � ' - <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYRIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> EUvT /yrnr,atE.�.��.—G/1oN/o OA� /.j•0a�i�74 y.2�- �.5� - 1//!/ <br /> CONTRACTOR A�DRESS CINIZIP PNONE <br /> 6�G/1C� S•N�r ••9/c .Zl�o P.�uF'ic Ac.E �'- �l8'•20( 2sz • ?//v <br /> CONTR.LICENSE# <br /> �1��.$So2� 07- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �F`���, _Electnc �Gas_Other ,z )0 0 - <br /> � <br /> WORK DESCRIPTION <br /> j- I SPi9GE Lon�P�E7� Du t7' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> Toilet A/C-air handling units <br /> Balhlub _ Forced air systems <br /> Lavarory(wash basin) _ Gas piping <br /> Shower _ Water heator <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher _ Gas renge � <br /> Clothes washer Cbthes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains _[ 01her!/i9Y �O)C <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby centify thal I have read and examined this application and know tho same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied with whether specifed herein or not.The granting of a permil does not presume <br /> to give eulhonty to violnle or cancol the provision of any other slate or local law regulating construction or the peAormance of <br /> constructio at I am authorized by the owner oF this property to perform the work for which application is made and I comply wilh the <br /> State ntrac rs Law 18 27 RCW an 296.200 WAC. <br /> , //-(� -O � <br /> Signature of Owned oNrador/Authorized Agent Date _ <br /> 'IZ <br />