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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 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AN TO 4 PM �' `�3—0� <br /> SITE ADDRESS PARCEL TAX I.D.# RMIT# � <br /> �o �� ;ll �r w �, 0 3 � ol�� Il�o �� ��� � O <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE p( -fj/�j- <br /> C'���'oc� ��.J�.Uf��'r.C.Y1�T LG-L �1�9Z-- (-��rwo�e�S r,�a z� �/y �c��xrn�S, til�1. <br /> TENANT NAME CONTACT FOR PERMIT � PHONE ZCC�-8(V��j SSZ <br /> Lb�� �I Ll �\ � E-MAILd(�I G�n I���G✓7�K •� <br /> CONTRACTOR ADD ES ITYIZIP HON <br /> i <br /> � <br /> CONTR.LICENSE# t, (f-��.C-� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eledric _Gas_Olher <br /> WORK DESCRIPTION <br /> �z�wol� c� e-X► 5� �u� a C ow� o�^`f" �ev` ��i t� <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handling unils <br /> Balhtub _ Forced air systems <br /> Lavalory(wash basin) ,_ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clolhes dryer '� <br /> Waterhealer _ Ranc�ehood r`!/ � � <br /> Sink(servicel�ar/mop/etcJ _ Exhausl fan `�r�,q U ' I <br /> Backtlow prevenler _ Heal pump �� <br /> Urinal _ Unil healer <br /> _ Drinkinc� Fountain _ Boiler �F <br /> Floordrain _ Refrigeralion �..�` <br /> Grease lrap _ Woodslove <br /> Roo(drains Ot'�er <br /> Olher <br /> CITY OF EVERETT LOCAI.SALES TAX CODE IS 3705 <br /> I hereby ceriti(y thal I have read and examined this application and know lhe same to be lrue and correcl All provisions ot laws and <br /> ordinaces goveminy this rype ol work will be complied wilh whether specified herein or noL The granting o(a pennil does not presume <br /> to give aulhority to violale or cancel lhe provision o(any olher stale or local law regulating con_,tnc:.tion or Ihe performance of <br /> conslruclion.Thal I am aulhorized by the owner of lhis property lo perform Ihe work for which applicalion is made and I comply with the <br /> Sta Contr� tor a 18.27 RCW and 2�J6.200 WAC. <br /> �� �,�_�— � ' IJ`�� <br /> Signalure of O vnedConlraclor/Aulhonzed Agenl Oate <br />