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� PcRMIT APPLICATII�N <br /> CITY OF EVERETT PERM9T SERVICES � S_o9 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-88?0- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �N��� <br /> SITE ADORESS PARCEL TAX I.D.# PERMIT# <br /> � l �/ . ' llu' y o S _ 7WU `�G' S --UI/ <br /> LEGAL LOT NO. BLOCf( TRACT OR SUBOIVISION 1! <br /> DESC. <br /> � <br /> OWNER ADDRE55 CINIZIP PHO 1�ZS-"34�{ � <br /> �I�� � U ;� i.',: ��n � I�� u ,!1 G �� S t S 1� 1= �107� UP `�'�ZG� �.7�. <br /> TENANT NAME :r rt �_/, CONTACT FOR PERMIT PHONE �� <br /> ` � . T , . .., . , . -. . . . � <br /> E-MAIL <br /> I NTRA T (� ADDRES I7YIZIP H N <br /> . � �� �-;1 :7i'�a � <br /> � �' i�J > �� " �, �P, /', zS 34� ���7� <br /> CONTR.UCENSL"# I�� I��/ S� SW"� � i�2t�%�(r Y <br /> ���?9/09 � � 257��9 . <br /> � USE OF BUILDING _ __- � HEAT SOURCE `/CONTRACT PRICE OF WORK <br /> j � 2 _Eleclric _Gas_Olher ' J .�j,r�� � (� :. � <br /> � r�,i . �.�.,� <br /> WORK DESCRIPTION <br /> G r�.r�-�je /''-�ecrs��`�� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handlina units <br /> 6athlub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas ran�e <br /> Clolhes washer Clolhes dryer <br /> Waler heater Rangc hood <br /> Sink(servicelbadmop/elcJ Exhausl fan <br /> i _ Dackllow preventer _ Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> � _ Grease Irep Woodslove <br /> �I Roo(drains _ Other _ <br /> Olher _ _ � <br /> � I <br /> CITY OF EVERETT LOCAL SALES TAJ(CODE IS 3705 <br /> II hereby ceritify lhal I have read and examined�his application and k�ow the same to be lrue and correcl All provisions o(laws and <br /> ordinaces�oveming Ihis type of work will be complied wilh whelher specified herein or nol The yranting of a permit does not presume <br /> I to give authority lo violale or cancel the provision of any other stale or local law regulaling construction or the performance ol <br /> �I conslruclion.That I am aulhorized by lhe owner of this properly lo peAorm the�vork for which applicalion is made and I comply with�he <br /> � S�ale ConlracCo�}s Law 18.27 RCW and 296200 WAC. <br /> - � <br /> ; �_l , f^�,'r.�1:/�� l ��3 -�� <br /> i SignaWre o Owner/Con ractor Aulhorized Agenl D2te I/ <br /> L <br /> I— --- <br />