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PERMIT APPLICATION <br /> CITY OF EVEP.ETT 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 �fl �a3,..Q� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# _�� <br /> z�a w ,�v�. , s�. r� �3 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANT NAME CC`NTACT FOR PERMIT PHONE 6 ;3'l- !322 <br /> �J(CR-rt�T'r V�NtiYMLD M�I�- MrcS'N�� E-MAll1�'��I�L�9MpN�£VW£ <br /> C NTRA OR A ORESS CI7Y/ZIP PNOh p <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �V�� _Electric �Gas_O:her � 7500� DO <br /> WORK DESCRIPTION <br /> INSi'A�-�-A+r(oN oF GAC FvElvacE. /N''D puc�woll.}_' ftyt qfr+�'rsPAc�� PLus cAr ptPriub <br /> FoR FuP-NYtG4, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC—air handliag unils <br /> Balhtub � Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal _ G2s fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Waler healer Range hood <br />' Sink(serviceNadmop/elc.) _ Exhausl(an <br /> Backllow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Ploor drein Refric�erelion . <br /> Grease trap _ Woodstove � <br /> Roof drains Olher � <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�705 <br /> I hereby cerilify Ihal I have read and examined this applicaliun and know lhe same lo be true and correcl All provisions of laws and <br /> ordinaces goveming ihis type of work�sill be complied wilh whether speci(ied herein or noL The granting of a permil does nol presume <br /> to give authority tu violate or cancel the provision of any other state or local law regulating construction or the per(ormance o( <br /> construclion.Thal I am aulhorized by the o�vner of this property to perform the work(or which application is made and I comply wilh the <br /> Sla�e Conlractors Law 1827 RCW and 296.200 WAC. <br /> �I� i <br /> �(.�`%��u� l0 23 �0� <br /> SignaWre of OwnerlConlractodAulhonzed Agenl Dale � � <br /> � Z <br />