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� <br /> PERMIT APPLICATION <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 �p_//— /� <br /> SITE ADDRESS PARCEL TAX I.D.# f'ERiIT# �� <br /> zo G'z <br /> �I'C T <br /> LEGA LOT NO. BLO TRACT OR SUBDIVISION M � <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANTNAME / CONTACTFORPERMIT PHONE <br /> C�Q.�L M'C Io�7 �L�C� �/�'�� trC� E-MAIL R+S�c�D <br /> C•�scadP � � .o Hmx 7�{sg �� "�' �D6 �x��°D � <br /> CONTR.LICENSE it C�,G• �j /]. / d` 2 �(,� pc f y <br /> �C..�»vr� ! <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other � � , Q v <br /> WORK DESCRIPTION �/ ,/ � O i� _ , ��L ' <br /> �' f '1!J v /7C�S� � N�KJ G�Q Q �G K� f7�.�u,.cv�� <br /> �„s-fe�-t� �/—N � <br /> � /� r1 ��dc� . T Y', <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A�C—air handling unils <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clolhes dryer <br /> Water heater _ Range hood <br /> Sink(servicelbar/moplelc.) _ Exhaust fan <br /> Backilow prevenler _ Heat pump <br /> Urinal _ Unit healer <br /> _ Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap Woodstove �' /_I <br /> Roofdrains ,� Other ��Cl-'� ��l/H'�< <R' <br /> (3'(her —N.� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby certiy that I have read and examined this application and know the same to be trua and cortect. All provisions of laws and <br /> ordinances governing this type o(wor ill 6e complied with whelher specified herein or not.The granting ei a pertnit does not presume <br /> to give aul ' o vidate or cance e provision of any olher state or local law regulating construction or the pertortnance of <br /> onslr ion.T al I authoriz y the owner of ihis property to perfortn the work for whfch application is made and I comply with the <br /> 3tat ontr ors 18.27 and 296.200 WAC. <br /> � �D-//-/ <br /> ture of OwnedC tr tor/Authorized Agenl Date <br />