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PERMIT APPLICATION <br /> CITY OF EVERETT PERMfT SERYICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—ww!v.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM"�O 4 PM � , �O .I(Z <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT p <br /> �.3 � 4� c�,�� � cv 3q �7°��� i ��cc� o � - <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ?��,.1 �' ', Q(��C� 1 l�, � i�V ! 'f � `- �0�Q2 l �V C -� Z 07 � VC' r c i'C �i�^ ��7� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> .,� ��c�.�rv gal� �c�vli � �on �,.g� u ches+��� Evc �'ei� i�l�, `(��o i `��5 j31 3111 <br /> CONTR.LICENSE� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other ''}-� r� <br /> WORK DESCRIPTION <br /> j�.z ,�u�; µ��. _ �--, �., ;, f h� , l �,(I, ',� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air hand!ing units <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitclien sink&disposal _ Gas fireplace <br /> Dishwaslier Gas range <br /> Clolhes washer Golhes dryer <br /> Waler healer Range hood <br /> Sink (service/bar/mop/etc.) _ Exhaust fan <br /> Dackflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roo(drains � Other <br /> Other <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I hereby certify Ihat I have read and examined this application and know lhe same to be We and correct. All provisions of laws and <br /> ordinances governing ihis lype of worfi will e wmpi�ed with whelher specifed herein or nol. The granting of a permit does not presume <br /> to give acthority to violate or cancvl the proyision of aryy other slale or Iocai law reguiating construction or Ihe pedormance of <br /> conslruction. lbal I_am aulliorized by the o(vner of tly s property to perform the work for which application is made and I comply with the <br /> Slate ContraGors Lav`18!77 RC1�,nd 29 �O WAC. � / <br /> � �_ •�-� J Z � <br /> _ i <br /> / ,;� �. / � ���1 <br /> Signature of OwnedContractor/Authorized Agent Date� , ' "" <br />