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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �/�a b'p7 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> � �J�_ APPLICATIONS ARE ACCEPTED FROM 8 AM TO4 PM <br /> SITE ADDRESS PARCEL TAl(I.D.# FER1.11T# <br /> - - — l�:�'�. `1 O� Z -C�� - ?��-c� \ I�G7�/-oo`( <br /> LEGAL LOT N0. BLO K TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER r ADDRESS CITY2IP PHONE <br /> �y o�'�� �'\��"� ��o�� l l l.,n/�- �� � ��� ��Z <br /> TENANT NAME ONTACT FOR PERMIT PHON c' 'Uj�� S'� ( — JC <br /> r- ���,.,� rv�� <br /> �G�/\ �.ST (� ^�1 e.eua�L�•rv�elcG..s� �nn::t,o•. <br /> NTRACTOR �IZS, `�� S� A6 R$S I� PHONE 2� n <br /> ///��� r i nc..� �rp�tLTc U n l,.(�. � � �'I-�( c <br /> CONTR.LICENSEp � I�� __�� �v I I� l� ^ <br /> « D � <br /> USE OFBUILDING HEAT SOURCE CONTRACT PRICE OF WORK q <br /> — — — � S <br /> Electric Ga� Other �� -�� T <br /> WORK DESCRIPTION ^ <br /> C <br /> T <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM �0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> �athtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> _ Greasetrap (Zc.�UC°',T� Woodstove <br /> _ Roof drains �Z I�C�� � � � �k.`� = Olher <br /> Olher I ^ J <br /> — �i�r� — — <br /> iv` , <br /> d— <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined lhis application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whelher specified herein or not.The granting of a permit does nol presume <br /> lo give authority to violale or cancel the provision of any olher state or local law regulaling consWction or the peAormance of <br /> construclion.That I n autliorized by the owner of this property lo perform the work tor which application is made and I comply with the <br /> Stale Conlraclor aw 1 .27 RCW and 96.200 WAC. <br /> I (- �- 0 `� <br /> SignaWr of OwnedContrac or/Authorize ent Date <br /> L� <br />