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PERMIT APQLICATION <br /> CIT`l OF EVERETT PEF:MIT SERVICES <br /> 3200 CEC�AR STREET, EVEr2ETT, WA 98201 <br /> 425-257-8810- FAX 425-257-885'' - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � — �`�U�S <br /> SITE ADDRESS PARCEL TaX I.D. # /P�ER�#� <br /> � '" !J O/�� ' vOC� <br /> �G' J(,� GG�,c:�' L . w- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC.j <br /> OWNER ADDRESS CINIZIP PHONE <br /> n <br /> �� � L�... C_�ficc �!r�f�r<; � /Z-, `_�i7 7 � �ti a <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> , _ /U-t�(� e.��, �.��cl;/�fnOr�`,u.� �Zf� Ll '��_'J�'� ' �nm E-MAIL <br /> � TOR ADDRESS ITYfZIP PHONE <br /> CONTR.LICENSE# <br /> j-�i/�/ ��i' f- /�/n/' <br /> USE OF BUILDIIJG HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,��� Eledric Gas Other <br /> .)./Z F� �� — — — -� G' � ''� <br /> WORK DESCRIPTiON <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUR[OR ITEh7 NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A�C-air handling units <br /> — g�p���� Forced air syslems <br /> Lavalory(�+ash basin) _ Gas piping <br /> Shower W ater heater <br /> Kilchen sinL.S disposal _ Gas(ireplace <br /> Dishwashc� Gas ranc�e <br /> Clothes washer Clolhes dryer <br /> Wa1er healer Range hood <br /> Sink(scrvicclbar/inop/etc.) _ Exhaust fan <br /> Back(low prevenler _ Heat pump <br /> Urinal Unil healer <br /> Drinking Fou�lain _ �oiler <br /> Floor drain Refrigeralion <br /> Grease Irap Woudstove <br /> Roof drains Othcr <br /> Olher <br /> CIN OF EVEREIT LOCAL SAIES TAX CODE IS]105 <br /> I hereby ceritify Ihat I have read and examined lhis application and know tne same lo be Irue and correct. All provisions of laws and <br /> ordinaces c�oveming Ihis lype of worh will be complied�vdh�vhelher specified hcrein or noL The granting e�a permit dues not presume <br /> lo give au�hority lo violale or ca�cel tY��e provision o(am�other stale or local law regulatinc� cons�ruction or tlie performance of <br /> conslruction. Thal I an aulhorized by the owner ol lhis property to perionn the work lor which application is made and I r,omply�vith ihe <br /> Slale CaNraclors La�� 18.27 RCW and ?_9G.200 WAC. � <br /> � ��t:<,<�� �Gc.l�i._�,��- .� 7—!�� <br /> ignature of OwnedCuntraclorlAulhorized A�enl Date <br /> I <br />