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� — <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES c�_ �v—c7 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �(,J ��� �� <br /> SITE ADDRESS PAR+EL TAX I.D.A �ER�T R� J <br /> -,- C O< . <br /> ���3c c�y�� ;� �r:��. �,,�, ::� :.��� c:�� � � :�;i 3 _ - <br /> LEG LOTNO. BLOCK 7RACT <br /> DESC. � ��� - `rk :.t' 'i��t ivC �'� a1' S��{ �7 � -:,,� .a�,.v� RL}% �i� <br /> ONMER ADDRESS CITY2IP PHONE <br /> ��^f'.. ". i�,_`1�=r.`I�- �iUl'i ��.. �„ � ...� '::�., ,,y '.�ti-LI.� ,-,-i.-. .� ._ :_���='{li-1-�: _ <br /> ! i" .t'7' <br /> TENANTNAME I CONTACTFORPERMR PHONE <br /> ( L � �� � .. l�(•.�.�Icn.l -: (.t - ���i..� _C.: �7� <br /> CONTRACTOR :�:�vr�;� c�t, C_..,1,.�_;' ADDRESS CIIYlLP PHONE <br /> CONTR.LICENSEN /y l�i�l \.% j'_`jl��l 1��>� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> c', i ;_ E-ledric ��Gas_Other �' 1 _j� , �;:"�;� <br /> WORK DESCRIPTION �.;��-�,.-' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIX7URE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet AIC-air handling units <br /> � Bathtub _{_ Forced air systems <br /> � lavatory(wash basin) � Gas�iping <br /> � Shower � Water heater <br /> ' Kitchen sink&disposal �_ Gas fireplace <br /> � Dishwasher � Gas�ange <br /> �� Ctothes vrasher Clothes dryer <br /> t Ran hood <br /> � S nk(serv ceR�ar/mopletc.) ✓ Exhaust fan <br /> � Badchow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeratlon <br /> Grease trap _ Woodstove <br /> Roof drains Other _ <br /> Olher <br /> I <br /> CiTY OF EVERETT LOCAL SALES TA%CODE IS 1105 <br /> I hereby ceritiy thal I have read and examined lhis application and know the same to be hue and cortect. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether spedfied herein or nol.The granting of a permit dces not presume <br /> to give authority to violate or cancel the provision of any other state or local law reguiating conskudion or the perfortnance of <br /> construction.That 1 am authorized by the owner of this property to perform the work for which application is made and I comply wit;i tne <br /> State Contradors Law 18.27 RCW and 296100 WAC. <br /> l <br /> � _� . i : ; . �� ly �%, �> �� <br /> SignaluPe of Owner/Contradof/Aathonzed Ayent Date \�Z <br />