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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 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO A PM <br /> SITE ADDRESS � PARCEL TAX I.O.# PERMIT# <br /> lSv�> l .S� D7�C . Qp� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWI�ER ADDRESS _ CITYIZIP PHONE <br /> �%r� c't /�,v�"// }�C? �S �.3dJ �v� �.��-b(� ��.>.5 �J�.�b7i�J <br /> TENANTNAME CO TACTFORPERMIT PHONE <br /> � f/ / / i .� <br /> /, JU �,L I� I'-e-(Cv��G\E-MAIL J��� � �/.� <br /> CONT ACT R �l AD RES �:TTY/ N <br /> o ((�'�' )) /� , U� <br /> CONTR.LICENSE# f I ��,,, r�j ` l� IU�i /�� /1�C'�'�'� SV� �l� �I � Q��� <br /> / <br /> USE OF BUILDING / HEAT SOURCE CONTRACT PRICE OF WORK <br /> i/��(,c n�l.t L :�c�' �/U' _Eleclric _Gas_Other <br /> WORK DESCRIPTION ' � ` L � ��y ��p�J i/y.�C <br /> �t-� C� oo 'f' 6�-�� tV. �. �.v � ' / <br /> �-�� /� � <br /> etS �1'�'l '/^' d�` �� 9'i��-f � �F�i+ /L) ',Jha-L UJ-Q/l.e lti?U-t'L (SSao <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air liandlinc� uni�s <br /> Balhlub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heatcr <br /> Kitchen sink 8 disposal Gas(irepiace <br /> Dishwashcr Gas range <br /> _ Clothes washcr Cbthes dryer <br /> N'ater healer Ranc�e hood <br /> Sink(serviceNadmop/elc.) Erhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unil healer <br /> Drinking Founlain 9oiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> Olh�r <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify thal I have read and examined Ihis application and know Ihe same lo be true and correcL All provisions of�aws and <br /> ordinaces c�oveming Uiis rype of work will be complied wilh whelhei specilied herein or not.The granling of a permit does not presume <br /> to give aulhorily lo violale or cancel Ihe provision ot any olher slale or Iocal law rec�ulatinc�conslmction or the performance of <br /> conslruclion.That I am authorized by Uie owner ot lhis property to per(orm the work for�5-hich application is made and I comply with the <br /> Stal �Gmylrac or ta� 18. a .200 WAC. <br /> � ����' 3 2� C�� <br /> Si . u e ot,Q�4ner/(,on raclor Ful orized Agen� Date I/� <br /> � <br />