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PERMIT APPLICATIUiV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320U CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetiwa.org <br /> �'�) ��l��/�����CJ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S .-�C►�-��O <br /> SITE AD PARCEL TAX I.D.# P MIT# <br /> l�� <br /> LEGAL I.Df NO. BLOCK TRACT <br /> DESC. � <br /> OWNER ADDRESS CITY2IP PHONE <br /> �'J'�-rlco r� <br /> TENANTNAME . CONTACTFORPERMIT PHONE <br /> �T�GIJ� - /,�Ue/�YG I /21.�0 �/yF-iJ22� �?52 '�f� ZJOO <br /> �r� r 7z� 3�33 <br /> GONTRACTOR ��,�(/� ��L ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUII.DING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas_Olher / 3 r'7 S�,��� <br /> — — . <br /> WORK DESCRIPTION ���y,/ ���v�Q�/�J`- <br /> /- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air hand�ing units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clcthes washer Clolhes dryer <br />, _ Waler heater _ Range hood <br /> Sink(serviceNar/mop/etc.) _ Exhaustfan <br /> Backflow preventer _ Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain _ Boiler <br /> I _ Floor drain = Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Olher <br /> O�her _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity lhat I h read and examined this application and know lhe same to be lrue and correcl. Ali provisions of laws and <br /> ordinaces govemi i k o ork will be complied with whelher specified herein or nol.The granting of a permil does nol presume <br /> to give aulhori o v' or ca el the provision o(any olher stale or local law regulaling conslruction or lhe performance of <br /> constructi . M d by lhe owner of thi>property to perform the work for which application is made and I comply with the <br /> Stale 8.' RC and 296.200 WAC. <br /> - � 6.S o3 D6 <br /> Siyn Ow Cr� oaL�:for/Authorized Agent �O� � f�� ''� <br /> C�a�) c]/"u/� ��/f� <br />