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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 <br /> SITE ADDRESS PARCEL TA7C I.D.# PERMIT# <br /> '-��t�s s�,�o � Po� � I-o�� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION q <br /> DESC. <br /> OWNER A�DRESS CITYIZIP PHONE <br /> �J ��fT /✓C�lC.li�� /f�f l��� /� S � �r/✓'.� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> � NTRA � .� �LC a ��M�/�`DD E S �—j�s �v� CI Y/ I J� <br /> J� / �Y2��–(� / <br /> CONTR.LICENSE N /� /�n�/ ^^ ��___,n^ �,( ' �✓�L ( <br /> /Zrri c_/'/J S �Sis <br /> USE OF BUILDING I — HEAT SOURCL I CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> _ Toilel A/C–air hand�ing unils <br /> __ BathWb Forced air systems <br /> __ Lavalory(wash basin) Gas piping <br /> __ Shmver Waler healer <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> __ Dishwasher Gas range <br /> __ Clolhes washer Clothes dryer <br /> __ Waler heafer Range hood <br /> __ Sink(service/bar/mop/etc.) Ezhaust fan <br /> _ Backflow prevenler Heat pump <br /> Urinal Unit hea�er <br /> Drinking Fountain Boiler <br /> _ Floor drain Re(rigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> �� Other L�//�'>T7� }��['�/l�� ��S'LQ�C � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify that I have read and er.amined ihis application and know the same lo be true and correcL All provisions of laws and <br /> ordinaces poveming this type o(work will be wmplied with whether specified herein or noL 7he granting of a permit does not presume <br /> lo c�ive aulnority to violate or cancel lhe provision of any olher state or local law regulaling consiruction or the peAortnance of <br /> conslruction.That I am authorized by Ihe owner o(this pmperty lo pertorm the work for which application is made and I comply with the <br /> Slate Conlractors�18.27 RCW and 296.2��A . <br /> � li <br /> �.�%-.•.,, _--%= -z I�//9 /� <br /> ISignature of Owned'�bnhaclor/Aulhonze�' Dat <br /> L <br />