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i <br /> NERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �V (./��� <br /> SITE ADDRESS PARCEI TAX I.D.1t PER T N <br /> ZSoI M Ei.vi'n� A-tiE po !� 70 ! 50 o f� 3 �O� -.�D <br /> LEGA LOTNO. BLOCK TRACT p <br /> DESC. $` PLA'7' oF PtNF'/t�LST VOL p �1�6 3 <br /> OWNER ADDRESS CITY/ZIP PNONE �,�\ <br /> / <br /> �ltvE M/+-f� L� d61 (7524 34�D�e NE ���'NS�u3 �44-4663 <br /> TENANTNAM[ G�IkSrLE W�� �•CONTACTFORPERMIT PHONE <br /> C�)NTRACTOR �WN� ADDRESS CITY2IP PHONE <br /> CONI.t.LICF.NSE N <br /> CS�'��� <br /> USE OF BUILDING HEAT SQURCE I CONTRACT PRICE OF WORK <br /> sPE'C CmN57'n ucTo� _Electric {/ Gas_Olher �9�29`1 <br /> . <br /> WORK DESCRIPTION <br /> �I ��J �� � �j L�l��ll�f�S <br /> � � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. iYPE OF FIXTURE OR IiEM <br /> � Toilel A/C—air handling units <br /> Z Bathtub L Forced air systems <br /> /„ Lavalory(wash basin) Gas piping <br /> � Shower Water heater <br /> � Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> - Clothes washer Z Clothes dryer <br /> 2 Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> �ack(low preventer ' Heal pump <br /> Urinal Unil healer <br /> Drinking Founlain 8oiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LUCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify Ihal i have read and examined lhis applicalion and know the same to be true and wrrecL All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or not The granting of a pertnit does not presume <br /> lo give aulhorily to violale or cancel ihe provision of any other slale or local law regulating conslruction or the performance o( <br /> constructi . am autliorized by the owner of lhis property lo peAorm the work for which application is made and I compty with the <br /> State C ntre rs 18.27 RCW and 296.200 WAC. <br /> (S O(� <br /> Signat o Owner ontraclor/Authonzed Agent ate �/L <br /> ( <br />