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1 ' <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 a- �I � `-I D <br /> SITE 4DDRES$ PARCEL TAX I.D.N PE IT# <br /> ��.��:' , �ti,r -� '�i��a � � /ln,c-021> <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> �ESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANTNAME CONTACTfORPERMIT PHONE <br /> ` ��(/!f .: J?�U`�_ E-MAIL <br /> �� `j � <br /> CONTR.LICENSE# - _ ... . . <br /> c�-�i ���7s�q�l p I ___..__ <br /> USE OF BUILDING — HEAT SOURCE �(. CONTRACT PRICE OF WORK <br /> 6lectric �as Other 1 �fjZ7��� <br /> . <br /> WORK DESCRI^T19N � <br /> f� _1 9` � ���`'�S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C–air handling uni�s <br /> 6athtub Forced air syslems <br /> Lavatory (wash basin) _ Gas piping <br /> Shewer Water hea�er <br /> Kitcl:en su�k 8 disposal Gas(ireplace <br /> Dishwasher _Gasranye. <br /> Clolhes washer . _ Clolhes dryer � <br /> Wale, t�eater ( / Range hood� <br /> Sink(serviceNar/moplelc) \- �EXh3ti'sl Tan <br /> �2ckflow p�evenler Heat pump <br /> Urinal Unit heater � <br /> Drinkiny rounlain _ Doiler <br /> Floor drain Retrigeration <br /> Grease Irap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby certify ihal I have read�nd examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordmances gov�ming this lype ol work�vill be complied�.vilh whether specified herein or not.The granting ot a permit does nol presume <br /> to give authority W violate or cancel the provision of any other state oi iucal law regulating conslruction or the perf•rmance oi <br /> consiructien. Thal liam aulhorized by the owner of this property to peAorm the work for which application is made and I comply with the <br /> Stale Contrac ods Uaw 18 RCW and 296200 WAC. <br /> �y-r�i�,� � ; j�,� ��o� � <br /> SignaWre o( nEir C , clodAulhorized Agent � ' Da�e <br /> _ ' <br /> I <br />