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( <br /> pERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERL'ICES <br /> 3200 CEDAR STREET, EVERETT,W 4 98201 <br /> 425-257-8810— FAX 425-257•8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �,a, 3 —O� <br /> SITE ADDRESS ''7 I � ` �.����, 1 � ,����L PARCEL TA%I.D.M PERMIT• <br /> - ;� - �1 11 \�11C�� ��l -�y�, <br /> LEGA LOT NO. BLOCK TRACT OR Sl18DIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE<�7t� '�{�L ��'�-i� <br /> i����_ �`l 11 Lll� ����1-1 1�11�> >�C � 1 '� 111 ��+��1�Y1 � 1�\,s ��:��r-+:1\ \�Il �I�r'L�1 <br /> TENANTNAME CONTACTFORPEHMIT PHONE ',��} � z[S�1'�`jZ� <br /> ��-L ' �-'\,� � '��:��� v .' �,� 'Vll� Y� `�1t'���1 <br /> .. `- \�...IIi��I1�_>I � E•MAIL :\l"11\I\1,1�� ��Ll�/� <br /> NTRA�S'fa��-1.�.�._� l � R ?rJ�S ) �\L•`���IfY I H `�12�'j\_ <br /> };� 11� i(-��1 (ll Il1 1 �� I �y'l�i ll`(� 111(_' � � � � <br /> i�i 1 � �+ 'c�_�. [�VC'f�rtt �Lr,c .����,�1�� <br /> cor+ra.uceHsex � �-I1=1��{1����'���I���� �14':Ll,� � <br /> USE OF BUILDING — HEAT SOUflCE I CONTRACT PRICE OF WORK <br /> Electric Gas Olher '`�, ��2. �L(,�.`,�(� <br /> WORK DESCRIPTION _j_.I � ��(\. I � �� �'., ��! ���1.��. � �� I ���l� ������- . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Show�er _ Water heater <br /> Kitchen sink& disposal Gas fireplace <br /> Dishwashe� Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> _ Sink�servlceibadmopietc.) Exhaust lan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> _ Uiinhing Fountain Boiler <br /> Floor drain � Refrigeraiion <br /> Grease�rap Waodstove <br /> Roof drains Other _ <br /> Other <br /> CITV OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby cerilily that I have read and ezamined Ihis application and know Ihe same lo be true and correcl. All provisions of laws and <br /> ordinaces goveming Ihis type ol work will be complied with whether specilied herein or not.The granting ol a permil does not presume <br /> Io give authority to violate or cancel ihe provision ol any other state or local law regulating cons�mction or Ihe perlormance of <br /> consiruction.That I am authorized by the owner ol Ihis property to perform the work br which applicalion is made and I comply with ihe <br /> S�ate Gonlraclors la 1827 RCW and 296200 WAC. <br /> � ��, � ,�. � 1 �.� ' _I �'> � �l <br /> Signature ol Owned nlraclor/Authodzed Agent Date <br />