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� -��-vS� <br /> PERMIT APPLICATIUN <br /> CITY OF �VERETT 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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> .S 2 �'/ C�f�� � S �9✓r' 15 i.�c,'�-o� p <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �/c- ���h ���r iSO�'� //r.�w �-�/11���/�� ��,��.,. 9Si�'� 206y5�7o '7 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> CONTRACT R "' AOD ESS ITY/Z!P PHON <br /> CONTR.LICENSE# <br /> USE OF BUILDING — HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> Eledric _Gas_Other <br /> WORK DESCRIPTION � <br /> ; )� /�C%� <br /> PLUMBING MECHANICAL <br /> NO. �TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ FVC—air handliny units <br /> -- Ba����ii�� ' _ Forced air systems <br /> Lavalory(wash basin) _ Gas pipinc� <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas firaplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clothes dryer <br /> Water heater Range hood <br /> Sink(serviceNadmop/etc.) _ Exhaust(an <br /> Back(low preventer _ Heat pump <br /> Urinal _ Unil heater <br /> _ Drinking Fountain Boiter <br /> Floor drain _ Refrigeration <br /> Gease trap _ �doodslove <br /> Roo(�rains _ Olher <br /> Other — <br /> � <br /> CITY OF EVERETT LOCAL SALES T/UC CODE IS 3105 <br /> I nereby ceriti(y lhat I have read and examined q�is application and kno�v the same lo be We and correct. All provisions of laws and <br /> ordinaces governing lhis type o(work will Je complied wilh whether speci�ied herein or nol The granting ot a permil does not presume <br /> � to give aulhoriry to violate or cancel the provision o(any olher state or local law regulating construclion or the peAormance of <br /> wnstr.:ction. That I am auQiorized by the o�vner o(this prop�rly to perform the work(or which application is made and I comply with lhe <br /> Slate Conlra��lorstia�v 1t1. f�CW and 296.200 WAC. <br /> �� �7 � <br /> %j/'�� ,l �� Z - <<'- O-�" <br /> Signalure of O nedConlraclodAulhonzed Agent �ate <br /> ���I <br />