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� - <br /> � 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 V -i6 -.�7 <br /> SITE ADDRESS ��/� PARCEL TAX I.D.N PER IT# <br /> . /�'r7 IZ 17�� ��� 7 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITY2`IP �)�,yPH��ONE <br /> �4l�1� i GLl�T� C�FORPY��. �.1 C/�' / /(/ —r'TN�^��frl��� <br /> z�3���/�� <br /> CONTRACTOR �" � /'��� A�DRESS . CITY2IP PHONE <br /> / �6i //�i \1 <br /> CONTR.LICENSEfI / /��( '�(?��,L� /F�/�'I,� I <br /> l � <br /> USE OF BUILDING HEAT SOURCE �� CQNTRACT PRICE OF WORK <br /> 1 <br /> L.,['�� _Eleclric _Gas_Other ���D 1 <br /> -�dC ' <br /> WORK DESCRIPTION <br /> ��S�Gru�b p�������n������s�l�. <br /> � T� ��� . <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling units <br /> �athtub Fo¢ed air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Cbthes dryer <br /> Laundry lray _ Range hood <br /> Sink(servicelbarhnopletc.) Exhaust(an <br /> Backllow pmventer Heal oump <br /> Urinal Unit heater <br /> _ Drinking Founlain Boilei ��� <br /> Floor drain ReNigeretion <br /> _ Grease trap �(�/� — Woodslove <br /> Roofdrains /�C- Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby ceritify that 1 have read and examined this appliwtion and know the same lo be true and correct All provisions of laws and <br /> ordinaces govemin iis rype of work will be complied with whether specifed herein or not.The granting of a permit does not presume <br /> to give authority o olate or cancel lhe provision of any other state or local law regulating construction or the pertormance of <br /> construclior, I am authorized by the owner of this property to perform lhe work for which application is made and I comply wilh ihe <br /> Slate Con ors aw 18+7 RCW an{2g6 200 WAC. <br /> 7 <br /> Signa r wnedCoNractorlAuthonzed Agent Date <br /> ��7 <br />