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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 4 PM �G —�j — O � <br /> pARCEL TA%I.D.A P�ER7MR fl /� <br /> SITEADDRESS - -� � I� / ��/I� ��L' <br /> .- � . .�`_� � / ,, �� i ` ' '�. <br /> :. � � � ,i r � r,,- . . <br /> ��� ��N� g�p�K TRACTORSUBDIVISIONA <br /> DLSC. <br /> OWNEH MDRESS C�TY(4P PMONE <br /> / <br /> � s� iiy � r .. /; ,« — �� 1��1c�_� `r.ts-dss- <br /> >, <br /> � � � - '� <br /> TENANT NAME1� � CONTACT FOR PERMIT PNONE .1 S L- � <br /> � 'y�1 S '.Z S �J'-„� S., , / <br /> <�:�:tir ��E�MIAILf��-/t� ic �) : 1 ; C�+i3 n1 <br /> � ' . �� � �� 1 . . , � Li . ' �) ; ' iS � � ](�- <br /> � i' i� L � �, l <br /> i: � . . - - � ., / � � �� , . - . <br /> �, <br /> CONTR LICENSE 71 /`i �� j�) <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 1��. <br /> �')� � . � Eleciric _Gas.{�Other /��! /� ') �: , j- , <br /> WORK DESCRIPTION .. <br /> � � � ���r� � <br /> _ �i ', I-' :i- _ , , . , ���- � -, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fll(TUfiE OR 17EM NO. 7YPE OF FIXTUHE OR REM <br /> Toilel _ NC-airhandlingunits <br /> Bethlub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Water healer <br /> _ Showei Gas fireplace <br /> _ Kitchen sink 8 disposal � Gas rango <br /> _ Dishwasher Cbthes dryer <br /> _ Clothes washer Range hood <br /> Waterheater Exhaustfan <br /> _ Sink(servioe/bar/mop/etc.) Heat pump <br /> Backflow proventer Unit heater <br /> _ Urinal Boiler <br /> _ Drinking fountain Relrigeration <br /> Floordrain -- Woodstove <br /> _ Giease trap — pther <br /> I = Rool drains - — _ _ <br /> 4 Other, <br /> CfTV OF EYERtTf LOCAL SAlES TAX CODE IS 3105 <br /> I hereby ceritily that I have read and examined this application and know Ihe same to be�rue and cortect. All provisions ol laws and <br /> ordinaces goveming Ihis lype of work will be complied wilh whether specilied herein or no�.The granting o�a permit does not presume <br /> to give authonty io violate or cancel the provision ot any other state a local law regu�ating consvuclion or ihe perlormance of <br /> construclion.That 1 am aulhorized by IhB owner of this property to perform Ihe work br whith application is maAe and I comply with ihe <br /> State ConVadors Law 18�7 RCW ar}d 296200 WAC. <br /> i . <br /> i <br /> � . '/.�-, ic 6 � �'�' S� <br /> � � � ,�,., <br /> S�gnalure o e n ra r� uthorize gent ate <br /> �--- <br />