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f PERMIT APPLICATION <br /> I PERMIT SERVICES <br /> CITY OF EVERETT , <br /> 3200 CCDAR STREET, EVERETT, WA�8201 <br /> 425-257-8810— FAX 425-257-8857—www•everettwa.org <br /> APPLICATIONS ARE ACCEFTED FROM 6 AM TO 4 PM � �� S�-�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> , ,� �,� . �� s-.�i �, r- _�E oo y 3�03$a o a So o ��I(.�^l>',-�-e�'�- _ <br /> LEGA LOT NO. BLOCK TRACT Oft SUBDIVISION# <br /> � <br /> DES0. ���� , n .�'.r �U � � l� �J I 1� �' <br /> OWNER ADDRE55 CITYIZIP PHONE �� ZS <br /> -�� �� � . i ' �' ^ l�lc�9 i ��-r��« ���. [�e �gZ� l [.Pio- �-l4to <br /> y �_,�-� �-,� - <br /> TENANT NAME CONTACT FOR PERMIT PHONE �`+�5� <br /> co�v-�+tito <br /> �Ol M+�' S , � CITYIZI E-MAIL H <br /> CO TR CTOR ADDRESS , <br /> CONTR.LICENSE# ! <br /> ��1 - <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ., Eledric _Gas_Other <br /> �.... �. c. � .r <br /> WORK DESCRIP N � ` � <br /> �� ,�, i_ D r. �.� �=��'c�5 �e 1(� X� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C–air handling unils <br /> Bathtub _ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Wa�er healer ,_ Range hood <br /> Sink(serviceNadmop/elc.) _ Exhausl fan <br /> Back9ow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain _ ftefrigeralion <br /> — Woodslove <br /> Grease trap Other <br /> Roof drains — <br /> � _ Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify ihat I have read and examined Ihis applicalion and knov�Ihe same to be�rue and correcL All provisions of laws and <br /> ordinances goveming lhis type of work will b�complied wilh whether specified herein or not. The granting of a permit does not presume <br /> to give authority to violate or cancel ihe provision of any other slale or local law �egulaling consiruclion or lhe performance of <br /> construction.TF� authorized by the owner of Ihis property to perform the work for which application is made and I comply with the <br /> Slate Conir e rs aw 1 27 RCW �d1296.2 W <br /> / '� UG <br /> � , i <br /> Si Aalure of n irac or/Aulhorized AgeM Da /.� <br />