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� <br /> F��RMIT APPLiCATI(�N <br /> CITY mF EVERETT PERIVIIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, INA 98201 <br /> 425-257-8310 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ( `N -p� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT tf <br /> � .0��7LL�1 1� � - �) <br /> LEGAL LOT NO. BLOClC TRACT OR SUBDIVI510��1 <br /> DESC. <br /> OWNER ADORESS C'TY/ZIP PHONE �2� <br /> t��Gti> �ICf= \q2� �o��il�la -��k--" i-��-�ti " �1�r7a3 o?�lU�l�qD�- <br /> TCNANT NAMF CONTACT FOR PERMIT ^ PHONE <br /> ��"��, I+� j\I�T-`���C E-MAIL <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSF.# . <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Eleclric _Gas_Other I <br /> I WORK DESCRIPTION � � J r �� � <br /> �j �� t-c_ �, <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel FUC—air handling units <br /> Bathlub Foraed air systems <br /> Lavatory (wash basin) _ Gas piping <br /> � Shower Waler healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas ranc�e <br /> Clothes washer Clothes dryer � <br /> Water healer Range hood <br /> Sink(serviceibadmop/etc.) _ Exhaust fan <br /> Eackflow preventer _ Heal pump I <br /> Urinal _ Unit healer <br /> Uri�king Fountain . ._ Boiler <br /> Floor drain Re(rigeralion <br /> Grease lrap _ Woodstove <br /> Rool drains Olher _ <br /> i Olher <br /> CITY OP EVERETT LCCAL SALES TAX :ODE IS 7705 <br /> I hnreby cerilify Ihal i ha��e read and examineA lhis apptication and know the same ro be true and ccrrecL All provisions o(laws and <br /> oidinaces goveming this lype o!work will be complied with whether specdied herein or not The granting of a permit does nol presume <br /> lo give authority to violate or cancel ihe provision of any olher stale or local!aw regulaling consWclion or lhe pedormance ot <br /> construction.Thal I am aythorized by lhe owner o(this propeAy to perform the work for which applicalion is made and I comply with Ihe <br /> State-eSilttastors La�v 18127 RC'�N and 296.200 WAC. <br /> � � �C !4 �b�i <br /> r 1 � �� ��� <br /> SignaWre of OwnedConlractorlAuthorized AgeM Dale <br />