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PERMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 3E201 <br /> �i25-257-d810—FAX 425-257-8857—www.everettwa.org <br /> , APPLICATIONS ARE ACCEPTED FROM 8 AM; TO 4 PM <br /> S1TE ADDRESS PARCEL TAX I.D.S PERMIT p <br /> 0 fi�a ���e� !��'� �v5�1�' ol �oc� ( v2 F�� r�-c, � � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CIN21P PMONE <br /> J(J�1 h lMl75 �Y 0 w. � L�2S �S�. S^I J� <br /> TENANTNAME CO^N�TACTFORPERMIT PHONE rJ� �4� ���I <br /> 5��� �.—vl ��(1� � N�TI1� l� �«�NSDI� E�NINL 1 <br /> � l 19T1 l,`I Nt�u.T�� �.�0 <br /> CONTR.IICENSE N � 5��v I � � G $'3 Q � <br /> l <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> WORK DESCRIPTION r <br /> -��Y����t � I��� ��tC I���o-T� �✓ ''�¢�'�L <br /> PLUMBIVG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathlub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Showcr � Waterhealer <br /> Kilchen sink 8 disposal _ Gas fire�lace <br /> Dishwasher Gasrange <br /> Clolhes washer Cbthes dryer <br /> W ater heater Range hood <br /> Sink(service/badmop/etc.) _ Exhausl tan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodslove <br /> Roof d ins ,(� _ Other <br /> � Other CT �U11i _CVCIn�f� _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> 1 hereby cerilify thal I have read and examined this applicalion and know the same to be lrue and cortect. All provisions of laws and <br /> urdi ces governing this type of work will be complied with whelher speci(ied herein or rwt.The granting of a permit does not presume <br /> to iv authonry to violate or cancel the provision of any other state or local law regulating construction or lhe perfortnance ot <br /> c ns uclion.TI at I am authorized by Ihe owner ot this properiy lo pertorm lhe work for which applicalion is made and I comply with the <br /> S n� s Law 18.27 RCW and 2�G.200 WAC. <br /> ' � f� ��7 <br /> Si^nalure o(OwnedConlraclodAulhonzed Agenl Date <br />