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P�RMIT APPLICATI(�N <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 TU 4 PM <br /> SITE ADDRESS PARCEL TAX I.O.# RERMIT� � � <br /> � ��: . .� � . . l�AI ' ' ' l� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> '— -OESC: � . .. . , . '. i_: - � <br /> i � _ ' <br /> OWNER ADDRESS .�_�• j - . .�_( i -�- CITYIZIP PHONE - <br /> . ,.1 � . _�. �-I � "-i I-�� <br /> /�_. .._ . . '- � � , - . . � . . � / U:J_i i1 �-.� , . <br /> � � � i C ; LI-l� <br /> TENANT NAME CONTACT FOR PERMIT PHONE _. �-! j • �1�I � l�� <br /> r <br /> n;� <br /> � <br /> , 1 i i . -_• � � <br /> 1 _, li �. . ..-��.� � � �—' � E-MAIL i� � r -� �'1 <br /> ONTRACTO ADDRC- S /ZIP PH <br /> ( �� i�'�_� ��.I ( - . <br /> CONTR.LICENSE# <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> l.,� � <br /> � i�, ` r � �� � �, , Eleclric _Gas Other - � ` �� � ;-' '- _ � <br /> — , • <br /> WORK DESCRIPTION L.l��. r-_ !� i � . � � <br /> WESTWOOD PLAT OF BLK 000 D•QO ALL TH PTfJ LOT 35 LY SWLY OF FOL BAAP ON LN OF <br /> TR 34 S50' 001,V 75FT FR MOST NLY COR LOT 34 TH S38'OB OOE TO NXN SELY LN OF LOT 35 <br /> PLUMBING MECHANICAL <br /> � :' <br /> NO. TYPE OF FIXTURE OR ITEM /" ' � N0. �-� � ��� TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handling unils <br /> Bathtub _ Forced air syslems <br /> Lavatory(was1�basin) __ Gas piping <br /> Shower _ \^/aler heater <br /> Kilclien sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clolhes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink (service/baumop/etcJ _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap _ Woodstove <br /> Roo(drains _ Other <br /> Other — <br /> CI1Y OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicalion and kno�v lho same to be lrue and correcl. All provisio�s of Iaws and <br /> ordinaces 9overning lhis type of work will be complied wiUi whelher speci(ied herein or not The granling of a permil d�es nol presume <br /> lo givc authority to violale or cancel lho provision of any olher state or Iocal law regulating construclion er the perform.:nce of <br /> conslruction.That I am authorized by lhe owner of lhis property to peAorm lhe work for which applicalion is made anc I comply with the <br /> Stale Contreclors Law 18.27 RCW and 296.200 WAC. <br /> � <br /> ��� ., - _ � l .� _�_i � � . �i� � . i. ��' r' _ �, � <br /> SignaWre ot OwnedContraclodAulhorized AgeM Date �/ <br /> �, �j_� <br /> �� <br />