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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 -4w�w.everettwa.org c1_ a q-o�' <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM n�o8o9-o y� <br /> SITE ADDFjESS r PARCEL TAX I.D.ft PERMIT N <br /> 2 S �c^ 1�k,,C r(' �c7�=t-c�-f� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> �ESC <br /> OWNER ADDRESS CITY:ZIP PHONE <br /> (Te� ����-u- 1 �12c �ry ' lS — <br /> TENANT NAMEy � �.C--ONTACT FOR PERMIT PHONE (,IZ S 7 2'S7� S <br /> � v��17(�rI � J ' M �l-N�. I�� E�NIAIL C � � d� T Sl� <br /> CaNTRACTOR - A66k�$ ' � � � � tt— <br /> `�1�. Nv�•�� y r�+��� v LL� ?�� � wr`1"M�'��� ��c e�.�i� w.� 9��-�1 <br /> coHrR.uceHse n ��r�rl ��5� ��� ��2 � �-S � `� �p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE 7F WORK <br /> rl" S 1 ��C� 1��c� � ��Electric _ Gas_Olher � ���� <br /> WORK DESCRIPTION�, � ,I<�—l� �� ^S 2 J 1��.�+ e�C1 V S I 't�� S <br /> I � V� <br /> PLUMBING MECHANICAL <br /> NO. NP�OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(H�ash basin) Gas piping <br /> Show.er Waler heater <br /> Kitchen sink 8 disposal _ Gas lir�place <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> _ Waler healer � Range hood <br /> 5ink(service/badmop/etc.) _ Exhauslfan �� <br /> Dackflow preveMer _ Heal pump <br /> Urinal Unil heater <br /> DrinY.ing Founlain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease Irap _ Woodslove <br /> Roo(drain, Othrr <br /> O�hcr <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby ceriti(y that I have read and�examined lhis applicalion and know Ihe same to be true and corred. All proe�isions of laws and <br /> ordinaces governing this lype,of wor will be wmplied wilh whether specified herein or not.The granling of a permil does nol presume <br /> lo give aulhority lo violala or cancel the provision ol any olher state or local law regulaling conslruction or the performaoce of <br /> conslruction.Thal'�I am aulY.onz�9py 1he owner�l this property to perfcrm lhe work 1or�vhich applicalion is made and �comply wilh Ihe � <br /> State CoNrectors Law 18.27 RCV��cL296..2B�1NAC. n ( <br /> � � — �'�� Q d <br /> Signature, %W ed ntrac dAuthonzed�ent Date <br /> � <br />