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PtRMIT APPLICATIGIV <br />CITY OF EVERETT PERMIT SERVICES <br />CITY OF EVERETT PERMIT SERVICES <br />9200 CEDAR STREET, EVERETT,WA 98201 <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425d5]-CB10- FAX - www.evere�twa.or9 <br />425-257-8810 -FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM C AM TO d PM <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />SITE ADDRESS <br />PARCEL I.D. <br />PARCEL TAX I.D. # <br />P MIT # <br />P/�q���1IT,S <br />�� <br />_ <br />�Il�-n�, <br />LEGAL LOT NO. <br />LEGPL LOT NO. <br />BLOCK <br />BLOCK <br />11iI.Ci OR SUBpVISIONI <br />TRACT OR SUBDIVISION # <br />DES—� <br />�S� <br />CITY/ZIP PHONE <br />•oouss cn iv vxart <br />OWNER ADDRESS <br />/� p <br />l�-or, Anf- `%5?/('„ v<S 2S7Gs� <br />LNOMf <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />CONTACT F PERMIT PHONE _ _ <br />' I � ��'_� `, �� �� <br />E-MAIL <br />E-MAIL <br />AD f <br />29.IIIihL`Tb� ADDRESS <br />N rRA T R <br />CONTR. LICENSER 1 <br />\ <br />USE OF BUILDING <br />USE OF BUILDING <br />HEATSOURCE <br />HEAT SOURCE <br />CONTRACT PRICE OF WORK <br />CONTRACT PRICE OF WORK <br />� SIULIfi �OMIu� <br />\l <br />�Eleclric Gas Othor <br />�Fkcve _Gas OIMn <br />wortH oescnirnox <br />WORK DESCRIPTION <br />qu.� �lnlJP.�972�zt �G bua �1itAize�.,4��2/ <br />� <br />0 Ns�rE Gan�eGe� �a �ar�MFs�/ <br />ti S U� � 64R�c /.u� �a �'� 1�EN7" <br />F LUM&NG <br />F LUMBING <br />MECHANICAL <br />MECHANICAL <br />TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />.�.'.. <br />� <br />Toilet <br />Toilet <br />/�C— airnardling units <br />A/C —air handling units <br />Ba1MUL <br />Bathtub <br />Forced air systems <br />Forced air systems <br />_ <br />_ <br />Laoabry�wa5l�Lazln) <br />Lavatory (wash basin) <br />� <br />Gas piping <br />Gas pp^9 <br />Shower <br />Shower <br />Water heater <br />Water heater <br />_ <br />NI�tIgn 51nk6Nsposxl <br />Kitchen sink 8 disposal <br />Gas fireplace <br />Gas fireplace <br />� <br />o�snwasoo� <br />Dishwasher <br />Gas �a� <br />Gas range <br />Clothes washer <br />Clothes washer <br />Clothes dryer <br />Clothes dryer <br />r <br />Y <br />Wader heater <br />Water heater <br />Range 1pa0 <br />Range hood <br />Sink (service/bar/mop/etc.) <br />Sink fee icvlC:Mdmup'ulc� <br />Exhaust fan <br />Exhaust fan <br />BxAllow p�aveMe� <br />Backgew prevenler <br />Heat pump <br />Heal pump <br />Urinal <br />Urinal <br />Unit �¢ale� <br />Unit heater <br />_ <br />UnnFlrv� Fountain <br />Drinking Fountain <br />Bolles <br />Boiler <br />_ <br />Floor drain <br />Floor drain <br />Refrigeration <br />Refrigeration <br />_ <br />Grease trap <br />Grease trap <br />Wwtlslove <br />Woodstove <br />_ <br />Roo(drains <br />Roof drains <br />Other <br />Other <br />Other <br />Other <br />CITY OF EVEPEii LOCAL 5PLE8TA'lCPoE 15 ]IM <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby certify 11�a11 M1a�v roYl and examined �Ivs a001i[afm and know the same to be true and correct. NI provisions W Uwe and <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />aN�naces governing this hype of wok will Uo compiled witM1wM1e�Mr specified �nem or not. iM1e 9�nlmp of a permit does not presume <br />ordmaces governing This type of work will be with whether specified herein or not. The granting of a permit does not presume <br />to Bove authority la violate o� Cenwl W provision of any other sale or local law �¢gubWq construction or Me performance �I <br />to give autllorily to or cancel the provision of any other state or local law regulating construction or the performance �f <br />am a,ullwr¢eJ by IM1a Owned of Mils property to perform �I�e wuM for which application is made and I comply with the <br />construction. Thal I am authorized by the owner of this property to perform the wurk for which application is made and I comply with the <br />construction. That <br />n�nJ 296.200 WFC. <br />State Contractors Law 18.27 RCW and WAC. <br />Stale Contractors 1B <br />n3]R(C�W <br />..`t l�d I�l�a- a IOC <br />Signalur of Owner ntractor/Authorized Agent Date r <br />5�9nala�MOwnIN n .o IP �Iwnzatl A0M1 �e 1I <br />IZ <br />Z <br />0 <br />PtRMIT APPLICATION <br />