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PERMIT APPLICATI�N <br />CITY OF EVERETT PERMIT SERVECES <br />3200 CEDAR STREET, EVERETT. WA 982C�? <br />425-257-8810 - FAX 425-257-8057 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FRO�d 8 AM i O 4 PM <br />SITE ADDRESS PARCEL TAX I.D. k <br />�� ���.1.�AAA ��v�"V�'V�'t ' ' '�.11i ','� <br />� LEGAL �LOT N0. - BLOCK � TRACT OR SUBDIVISION M <br />n <br />� �' �. �. � _ ' 1 � ' � �� '-. ! 1 ' �. 1 � , � , ! '1 'i �',.1 J , '� � A� l V c { �� �� �; . � i '� l �_ �— ` 1 ` � ,a r.. ( . � , <br />TENANT NAME � � I CONTACT FOR PER1diT PHONE � <br />E-MAIL <br />NTP T R��C.�.,.. i�� �l�_>11�1-1i'��ll-1 �i AE �T .Z N <br />! :.� I I Il�r ,.�.. � .. . � <br />� �. . �'�. i.�.�, . . . , '%1` , <br />CONTR.LICENSEp i� i � � � ( r���- r �, 1 � .� � . . l' - . . <br />�. `' , .. . . . . . � <br />�� USE OF BUILDIIJG I HEAT SOURCE 1CONTFACT PRICE OF WORK . <br />� +'., <br />.. ����,����� <br />WORK DESCRIPTIOt: <br />� <br />N0. I TVPE OF FIXTURE OR ITEM <br />Toilet <br />Balhtu6 <br />� Lavatory (H aeh basin) <br />Shower <br />� Kitchen sink & disposal <br />Dishwashcr <br />- Clothes washer <br />Nl��,:r heater <br />Sir-. (s�rvice�6armop'etc.l <br />Backllow preventer <br />Urinal <br />_ Drirking Founlain <br />� Floor drain <br />i Grease I�ap <br />Rool drains <br />Other <br />__Electnc y'_� Gas Other `�� ������ <br />, _ . � � .. �� ri' <br />�,2pa�� `�+'�+��-C-�ur`1� <br />��0. I TYPE OF FI%TURE OR ITEM <br />A,'G — air handling unils <br />Forced air systems <br />_ Gas piping <br />Water healer <br />_ Gas Irteplace <br />_ Gas range <br />_ Clothes dryer <br />Range hood <br />Exhausl fan <br />Healpump <br />Unit heater <br />Boiler <br />Relrigera�ion <br />Woodstove <br />Other <br />CITY OF EVERETT IOCAL SALES 7A% CODE IS 3105 <br />I hereby ceritity thal I have read and examined Ihis application and know tlie same to be true and correct. All provisions ol laws and <br />ordinaces governing Ihis type of work will be complied wilh whether specified herein or noL The granting of a permit does nol presume <br />to give au�hority �o violale or cancel Oie provision of any other stale or local law regulating conslruction or the pertormance of <br />construclion. That I am authorized by the owner of this propaity to pertorm the work lor which application is made and I comply with the <br />Slale Contractors Law 1827 RCW and 296200 WAC. -'i <br />I" .-i <br />1 � �� � . r � I . ' . . �1 - � �•� <br />