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� P�RMIT APPLICATICrN
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<br /> i CITY OF EVeRETT PERMIT SERVICES
<br /> c� ; I 3200 CEGAR STREET, EVERETT, WA 98201
<br /> a 425-257-8810— FPJC 42;-257-8857 —www.everettwa.org � � b i0�
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<br />,�- . APPLICATIONS ARE ACCEPTED FROM 8 A.A TV 4 PM
<br /> �fi.:
<br />'�t,. SITE ADDRESS PARCEL TAX I.O.# � ERMIT#
<br /> : s:U. � - , �`/ -�i2-/
<br />'?^ ''�'� LEGAL LOT NO. BLOCK TRACT
<br />:�s��"', DESC.
<br />��.�;r��;�. OWNEft ADDRESS CITY/ZIP PHONE
<br />,�s,, L�� �r� e�: L�' // ��r''l� 8
<br /> nuy TENANT NAME I C NTACT FO RMIT PHONE
<br />!���. l''l'� ��l�r�� � �?'� /��i� �/�5'-o/D 's'8y/
<br />��''�"�" � CO'�TRACTOR AD SS CI1Y IP PHONE
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<br />� , y�G���,ec�t 7`��.,.�/r�- �.� �3�� �s3,.Q,� S.E. S �,-„��o �o.7s�r�r
<br /> ., CONTR.LICENSE�i
<br />,��y�,,''. .�i`1�;P.�Sr'087�C
<br />,'Sr'�"� , I USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK
<br />�4��.,,,.i f✓/.�`� /�r.11(�� i�s _Electric _Gas_Other
<br /> L¢r/ { 1'�SV/ L
<br /> WORK DE/SCRIPTION � � f � /J�
<br /> '�", � /1f7G� c2��fIF/Ctf �f/S�CYn Y' /t��lt G� �"�(
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<br /> PLUMBING MECHANICAL
<br /> ?`'u��'� NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM
<br />� Toilet AIC—airhandling.unils
<br /> � �� �athtub Forced air systems
<br /> � � Lavalory(wash basin) _ Gas piping
<br />'�"�'��` Shower _ Walerheater
<br />�.'r Kitchen sinrt&disposal _ Gas fireplace
<br /> �'�"' : Dishwasher Gas range
<br /> Clothes washer _ Clothes dryer
<br /> .�t�'�✓�� Waler heater _ Range hood
<br /> .M I Sink(serviceNa/mop/etc.) Exhaustfan /
<br /> r`' ' Backflow preventer _ Heal pump i
<br /> � Urinal _ Unit heater ,`�
<br /> ,i,
<br /> ;�p�� � Drinking Founlain _ Boiler �� �.
<br /> �I�� _ Floor drain _ Retrigeralion - ,�}
<br /> nt Grease lrap Woodstove l� �\�
<br /> � �� _ Roof drains � Other_.�liK� � �1;� 1
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<br /> I CITY Of EVERETT LOCAL SALES TAX CODE IS 3105
<br /> ; , I hereby ceritify that I have read and examined lhis appl�cation and know tne same to be true and correcl. All provisions of laws and
<br /> � ordinaces governinc�lhis type of work wdl be complied with whether specified herein or not.The granting of d permil does not presume
<br /> lo give au hority to violaie or cancel the� nvision of any other slale or local law regulaling construction or the pedormance of
<br /> constru i n.Th am aulhor'_ed by the �wner of this property to perform the work for which application is made and I comply wilh the
<br /> i Stale rac Law 1 CW and 296.20D WAC.
<br /> ,�-� ��S
<br /> Signa o Owner/Contracror/Aulhorized Agent Date
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