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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 �Z -/Z—j)� <br /> SRE ADDRESS I PARCEL TAX I.D.K PERMR N � <br /> -�-� � .��� �l,_ ; \ _>� , l � �'o;.,,�c�3vooG>�c�c �_: v� //� 0�� <br /> LEGA LOT NO.'� BLOCK TRACT OR SUBDIVISION 1 • <br /> oesc. Lc�\ � �C�' 1��1� l 'x�AC : .-• 1_�1c ��� ���C��� tC'v� <br /> OWNER AUDHESS -_ CfTY21P PHONE t��� �_,Z`>,,,1 l �' '( � <br /> �)� �-�1��t� ���,' �,��i�- 1( � �"`. ;, 3 :1c_:_� � � �lE��� . C.:; t �� �t� � 1�,��C��l �� ���t��.:` ��- <br /> TENANTNMIE , , I CONTACTFOR HAAR PMONE �\Z�� ' ��l�l - _�ly��(.� <br /> i \ � <br /> �i_, \ l�_4�� �;CC �_ _��� CC. .i� t���� �_�tC�� iLG�' E�MIAL ��h�C�C��IiL�: ��' y�i�� � �-� t; <br /> COfiTR,C CITVR <br /> CONTA.UCENSE R CJ� 1�-C_/V � <br /> i <br /> � ���1��5 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��� •._, t � C � � � f I ✓Eicctric _Gas_Olher I� � 3��� �` . L � <br /> WORK DESCRIPTION � _��' � � - <br /> � _�_ . .,,����L �. -� � . �'�'�l, l .�-�� '_�` i�.�� (' C_t �.,V i �C�.VC��'q�l <br /> � �';I '� �_` .. '..�` ' '._ �� _ � v, �, ��_ t �-1 �_) l�'�L . L.l�(-�J_'. 1�� �''_ c �� G��, i-�. � �(- � 1� <br /> . v�`C_;�����'f C�_�t� � l �_l�`�.c.�_C.�-�—L. CILC�LC��.�lt � \C'� l�_`( :�� � "1(Xtl <br /> PLUM ING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYPE OF FI%TUNE OR ITEM <br /> I Toilot A/C-air handling units <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) Gas piping <br /> Shower � Water hoater <br /> Kitchen sink 8 disposal Gas lireplace <br /> Dishwashcr Gas range <br /> J_ Clothes washer I Clolhes dryer <br /> 1� Water heater Range hood <br /> Sink(service/badmop/elc.) � Ezhaust fan a <br /> Backflow preventer Hea�pump <br /> Urinal Unil heater <br /> Drinking Fountain Boilor <br /> Floor drain Refrigeration <br /> Grease Irap Woodstove <br /> Hoof drains Other <br /> Olher <br /> �' dTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity Uiat I have read and examined Ihis application and krrow the same to be tme and correct. All provisions of laws and <br /> ordinacos goveming this rype of work will be complied with whelher specified herein or not.The granting of a permit dces not presume <br /> to give auttiwity to_violate or cancel Uie provision of any other state or local law regulaling consiruction or the perlormance o1 <br /> construclion.T t I am eutporized by ihe owner otlhiSprop 'to pedorm the work for which applica6on is made and I comply with the <br /> Stale Conlrac rs Law 18.'L`J RCW a�296:200 WAC. � . <br /> ;�/i <br /> �_ r . � C� - 11 � , y. <br /> SignaWre o- edContracbr/A lhonzed Agent ' Date <br /> � I <br /> l� <br />