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NERMIT APPLICATION <br /> ��TY O�' 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 <br /> SITE ADORESS n � (✓ PARCEL TAX I.D.# /P�ER(�T#� , <br /> 1 IQ�C� �j� �verr� � 5 � '� !j [j�� ' ��� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDI` l'JON# <br /> DESC. <br /> OWNER ADDRESS CIN/ZIP PHONE <br /> ��er�il 1%1-,l� ����c� �,.�{ �n� �6L �o�� S�; ���r�l ��-.IIUI� ,- f^,o6 <br /> � E����l' ulF 1ti::o� 61d_�$OI <br /> TENANT NAME �yh{ C� IeCi CONTACi FOR PERMIT PHONE <br /> � � I�I Z _ �i�, E•MAIL <br /> C NTRACT R 'I p� ADDRESS CITYIZIP PHONE <br /> I:VCf�! '�G�� ��(.l: <br /> ?�,,,i�,�,��i: �wn�� l�i� sc e��,z� M,rll [vere� 2�� �r8 �F�B� <br /> CONTft.LICENSE k ������ � J;�� ��� w� ��NG� <br /> USE OF BUILDING HEAT SOURCE µCONTRACT PRICE OF WORK <br /> `"J�S,C e SS �Elecfric _Gas_Olher `r �5 O0� <br /> i <br /> WORK �ESCRIPTION <br /> �T��«= I�e�m��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet � AIC—air handling units <br /> Bati�lub Forced air systems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower Water heater � <br /> Kitchen sink&disposal Gas fireplace � <br /> Dishwasher Gas range � <br /> Clothes washer Clolhes dryer � <br /> Waler heater Range hood � <br /> Sink(service,'badmop/elc.) _ Exhaust fan <br /> � _ 3ack(low preventer _ Heal pump <br /> Urinal Unit healer <br /> I = Drinking Fountain = Boiler <br /> � Floordrain Refrigeration <br /> 1 Grease trap _ Woodstove <br /> � _ Roof drains _ Other _ <br /> i _ Olher — <br /> i <br /> CITY OF EVERETT LOCAL SA!�S TAX CODE IS 3105 <br /> I hereb��cerilify that I have read and examined lhis application and know lhe aame lo be Uue and correct. All provisions of laws and <br /> ordinaces governinc�ihis type o(work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authoriry to violale or cancel the provision of any other stale or local la�v regulaling construction or the periormance o( <br /> construclion.That I am ulhorized by lhe owner of lhis properiy lo perform�he work tor�vhich applic2tion is made and I comply wilh lhe I <br /> State C nhact, s� aw 827 RCW and 296.200 WP.C. �I <br /> � g � Op I <br /> Signat�re ot wne ontraclor(Authorized Agent Dale <br /> � -- _ _--- _ - -- -- -`�--i <br /> � <br /> � <br />