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PCRMIT APPLICATICiN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TQ 4 PM � s� ��Z <br /> SITE ADDRESS (3 vyc� � PARCEL TAX I.D.# PERMIT# <br /> =''°700 �� �� <br /> LEGA LOT NO. BLOCK TRACT � <br /> DESC. <br /> OWNER q�� � �.'�_` ADDRE�^S CITY2IP P E <br /> 1 �'�V�"'�^� 1 �77� � Z�O� ��� <br /> _j����tr�¢, �am�' I�JA �' z� tytclr.� �a�n�. <br /> 7ENAN7 NAME CONTACT FOR PER T PHONE <br /> �q,,`",� AS �`IEiZ <br /> CJNTRACTOR '� ',�'-!`�1('�j"'�DDRESS p�O� � CITY2IP PHONE �2� <br /> CONTR.LICENSE# ,_r� L����r� • � p�,��``�� � � <br /> Nw — �LYJ11 � <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �N �lO��j I _E�ectric _Gas_Other � ys� ��� <br /> WORK DESCRIPTION ���� � � ,� <br /> � F�xyv�la-ka� ' v�e��rre� be w�rr,�l. <br /> q s� f� Fdr��# ���rr� � a�'�c. <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel h'C—air handling unils <br /> 9athlub Forced air systems <br /> _ Lavalory(wash basin) _ Gas pipin� <br /> Shower � �'\ _ \Vater i;�sler <br /> _ Kilchen sink 8 disposal �f) . �' _ Gas fireplace <br /> Dishwasher (', �(�'� _ vas renge <br /> Clolhes washer '�', '� _ Clolhes dryer <br /> _ �, y �� ������ Ran ehood <br /> S nk(service/badmop/elc.) �1 � _ Exhaust fan <br /> _ Back(low preventer �'1 l' _ Heal pump <br /> Urinal � !. __ Unit heater <br /> Drinking Founlain ' _ Boiler <br /> Floor drain RPt:iyaralion <br /> Greasolrap _ W�odstove <br /> Roo(drains l"��her <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS 3�05 <br /> I hereby cerili(y lhat I have read and examined this application and knok�lhe same to be lrue and cortecl All provisions of laws and <br /> ordinaces yoveming lhis type of work will be complied with whelher specified herein or noL The granling of a permil does not presume <br /> to give aulhority lo violale or cancel Uie provision of any olher stale or local law regulating construclion or the pedormance of <br /> conslruclion.That I am authorized by the owner oi lhis property to perform tho work for which application is made and I comply wilh the <br /> State Contrac rs Law 18.27 RCW and 29�.200 WAC. <br /> � . � <br /> Sic�nalure o Owner lractor/ uthorized Agenl Dale <br />