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, <br /> � PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org ���'Oz"��J�' <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �D�GZ -oo <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � t' 7 �acke�e��� r �� <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER AD�RESS CITY2IP PHONE Z�— Z_!�S V <br /> Cf �::� <br /> `� IEIZIZG £ f�-LISf� '�'��S �� b7 ��crGEpE�c.G12 E��� `�' <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> E-MAIL <br /> O RA T D ITYIZIP <br /> CONTR.UCENSE M <br /> USE OF BUILDING HEAT SOURCE ONTRACT PRICE OF W RK <br /> � i <br /> Py'�✓y'�' 1�('Sj�t�(Cfi I _Eleclric �Gas_Other I � �D�� <br /> WORK DESCRIPTION j`���7 <br /> � e���`e v�� (��J°� � ne� �� ;: �.;�� � �n��c <br /> tZ eP I� �� o I� v���� � ,�� t�v�— Sl�,f �C'o cl� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C—air tandling unils <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower _ Water heater <br /> � Kitchen sink&disposal Gas Tireplace <br /> _j_ Dishwasher _/_ Gas range <br /> �_ Clothes washer Cblhes dryer <br /> Waler healer � Range hood <br /> � Sink(service/bar/mop/etc.) � Exhaust fan <br /> Backtlow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain � Boiler <br /> Floor drein _ Reirigeralion <br /> Grease trap _ Woodstove <br /> Roof drains _ Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined lhis applicalion and know the same to be irue and correcl. All provisions oi laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or nol The granting of a permil does not presume <br /> to give aulhority lo violate or cancel lhe provision of a iy other state or local law regulating construction or lhe performance of <br /> conslruclion.That I am aulhorized by the owner of lhi>properly lo perform lhe work for which applicalion is made and I comply wilh lhe <br /> State Cqi� ar�ors Law 18. 7 R�CW and 296.200 WAC. <br /> � ��?.� � C^c�fi�i_�/ _ /� ) S - C� `� <br /> SlgnaWre o(OwnedConlractodAuthonzed Agent Dale <br />