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F`RMIT APPLICATI(�N <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 4 PM �— a—�—� / <br /> L <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � .�, � % � /�70/f�;�� <br /> �/c.c� <br /> LEGAL L � O. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER A�DRESS CITY/ZIP PHONE (�,�s— <br /> �,� . n <br /> �i� � , ,,� ��.� R��� l��� '�.e ��% r'�ir��l ��<a 3 �s3-o.,2 � S� <br /> T[NAN�'NAM CON T FOR PERMI PHONE <br /> ✓ <br /> E-MAIL <br /> �TRA O � � � ADDRES ITY21P E <br /> /�,:�c,- �z�-�� r •—�-�� ,�����f <br /> CONTR.LICENSE p ���.L✓L(�C/�t-�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Olher <br /> VJORK DESCRIPTION <br /> I PLUMBING MECHANICAL <br /> NO. TYP[OF FIXTURE OR ITEh7 NO. TYPE OF FIXTURE OR ITEM <br /> Toilcl A/C—air handling units <br /> �alhlub Forcr,d air syslems <br /> Lav�lory(wash basin) � Gas piping <br /> Shawer Water healer <br /> _ Kilchen sink R disposal � Gas firr.place <br /> Dish�vasher Gas rangc <br /> Clolhes washer Clolhes dryer <br /> W aten c�ater Rangc hood <br /> Sink(service/badntup/e�c.) Exhaust(an <br /> Oackllow precentcr Heal pump <br /> Urinal Unit healer <br /> Drinkinp f-ouNain doiler <br /> Floor drain Refrigera�ion <br /> Groase lmp Woodslovc <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SAL[S TAX CODE IS 7105 <br /> I hereby cerilify Ihal I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces goveminp lhis type of work will be complied with whethrr specilied herein or noL The granting of a permit does not pres��.,ae <br /> I to give aulhority lo violale or cancel Ihe provision of ony olher staie or local law regulating construGion or the perlormance ol <br /> construclion.Thal I am authorized by the owner ot lhis properly to perlorm U�e work for which application is made and I comply wilh the <br /> St�lc ordradors Law 1 27 RCW and 29G200 W C. <br /> �/ � ^ \� 7//Ji� /,_'r-`'� — <br /> Sig , ure of Ownerl onlraclor/Aulhortzed Agent Oale <br /> _ — — � <br />