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PtRMIT APPLICATI�N <br /> CITY OF 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 G ,�„g—�> <br /> SITE ADDRESS PARCEL TAX I.D.N PERMITM <br /> �a S � �!� - / <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �v� �/O�rS ��d` ��O ,��5 ��� �:-�� �/ <br /> TENANT NAME CONTACT FOR PERMIT PHONE�/�,�D-3$/ <br /> �75 �ft�� I �� E.MAIL�R,Q'g'�l/hG'I'/C!�� <br /> /�'/�tt?�l �'ii�Y�'�jo o).�� /S�� � SGr Srre�va«isL, q�5� y�s3.�f �' <br /> COJ�TR.LICENSE p <br /> I�(�`��i��s�L`�8 7l�/� <br /> USE OF BUILDING HEAT SOL'RCE CONTRACT PRICE OF WORK <br /> � <br /> � �.�9/ �� _Electric _Gas_Other � ��t� � <br /> WORK DESCRIP ION <br /> �S�i// �Yriv �� �.,al/ �rs�� ,�%�a�.� ��D�i•� �� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothos dryer <br /> Water heater Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founfain Boiler <br /> Floor drain Refrigeretion <br /> _ Grease trap Woodstov . <br /> Roof drains Other 2 ✓�/ !✓ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ccritify Ihal I have read and examined this application and know ihe same lo be true and correct. All provisions of laws and <br /> ordinaces oveminc�this type o(work will be complied wilh whether specified herein or noL The granling of a permil does not presume <br /> lo give a rity to violale or cancel the provision of any other stale or local law regulating wnstruclion or lhe perfortnance oi <br /> construc o .That n autho ' ed by Uie owner ol this property lo peAorm the work tor which application is made and I comply wilh lhe <br /> Slate Co actor w 18. W and 296.200 WAC. <br /> �u � _ �.�-�..p7 <br /> Signa r of OwnedConlraclodAuthorized Agent Date , <br /> � <br />