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FcRMIT APPLICATIt�N <br /> CITY OF EVERETT PERMIT SERVIC�S <br /> ?200 CEDAR STREET, EVERETT,WA 9820? <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.or� � <br /> APPLICATIONS ARE ACCEPTED FROM 8 .4N TO 4 PM II <br /> i <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI?'A I <br /> �� <br /> , � - - ,i L �10= — / � <br /> �, .- , . : �' _ , <br /> LEGAI LOT NO. OLOCK TRACT OR SUBDIVISION p � I <br /> � oEsc. ��„ d � � T?! �. �, �;...,� �.�,., _� �'� � :, � . '' ' DIV j <br /> i OWNER � � ADDRESS ; CITfIZIP PHONE��3 jq��1r1� I <br /> I . _ J! <br /> I <br /> i (� �� ;, � . {' ►^s �� u�� c� �c���,i � (,�, r,�� ����, �, l,�_ Cvt-;:r�l � .1� a o <br /> TENANTNAME ._.. I CONTACTFOR�RMIT l� PHUNF. � — <br /> I I <br /> �����_.� � � E•MAIL <br /> ONTRACT R ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE N �� �, <br /> ,��.,U i�C��,_� <br /> USE OF 6UILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �IL�� � � �rU�t- �� � ������ _.Electric _Gas_Other <br /> WORK DESCRIPTION '—� �/ <br /> ��r � 1 �� �(• n1i�" G' '� ��1 Cc.�lU[.'- 2Xi5��h� Gt7f�ir�.�� ��tti� �� <br /> ..: <br /> � . � r �; ,�; �' . — <br /> i � `PLUMBING � MECHAN�CAL <br /> NO. TYPC-OF FIxTURE OR ITEM NO. TYPE OF fIXTURE OR ITEM <br /> Toilel _ �C—air handhng unils '� <br /> �i Balhlub Forc�d air systems �. , <br /> I _ Lavatory(wash basin) 1 _ 6as PiPing ._ ,� � <br /> Shewer Watei healer ( 1 � � <br /> ' Kilchen sink 8 disposal � Gas fireplace � ���,J <br /> Dishwasher _ Gas ran e �' � I1 q <br /> Clotheswasher _ Cbthes9ryer � ��{� (� �}L�� <br /> Water h�aler _ Range hood �ll� I ��/-� <br /> Sink(servicelbarlmop/etc.) _ Exhaust tan • � �/ <br /> Backflow prevenler _ Hcat pump <br /> � Unnal _ Unit hcater II <br /> Drinking Fountain _ Boiler <br /> Floor dra� _ Refrigeration <br /> -- Grease lrap aVe 10Y �v 1— ��Ar Y wf 14J�{�� <br /> � Roof drains ��he�— I <br /> Olher — � <br /> _ ; <br /> CITY OF EVERETT LOCAL SAlES TFUC CODE IS 3105 <br /> , I hereby cerilify that I have read and examined Ihis applicaticn and know the same to be true and correcL All provisions of laws and � <br /> �� ordinaces governing ' .type ol work wi b complied wiil helher speci(ied herein or noL The granting o(a permil does not presume I <br /> � to yive aulhority to 'olat2 or cancel the pro �ision of any ther st��e or local law regulaling cunstruction or the peAormance of <br /> li consir tion. That I� 3ulhorized by e vner of Ihis �ropeity l6 periorm the�+•ork tor w�ich application is maoe and�comply with the , <br /> Stale �nlrador a 18.27 FCW an 1 .200 WAC. aa rC� U . <br /> SignaW of OWner o ractor/Authonzed Ayent a�e I',, <br /> � �Iz <br />