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� PERMIT �PPLICATION <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 AC�CEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �' � � � � � � � � PARCEL?AX I.D.R A <br /> � . . �.. � . C�"> �G� -rl � <br /> LEGA LOTNO. BLOCK TAACTORSUBDIVISIONi <br /> DESC. <br /> OWNER AUDRESS G'iYZP PNON �-,, -�).`,.-i'. . - .. �� �. <br /> ` � _ <br /> \'1 � � ' ' ..,. ., - , i � �.' � (� . '.i r l '�A�i i � 1 'I-t 1 �' �,; <br /> TENANT NMIE COMACT FOfi PERMIT ., ,PNONE 'i �..�-��<���� � �J��� <br /> 1A '.� �� A � � � �� A� <br /> .� ;� �..�.\ -).��.� E�IAIL � 1 i .� i,� ��. \ 1',',y_L` 1 � � <br /> _. 'i'-� '��A�i; , ' i A <br /> . . .i , , .. . �, � <br /> � . . , �, ._ . �_ - � - i <br /> CONTR.LICENSE p _ _.. - � <br /> _ . . . . . :.� � .���I . � - '� <br /> � USE OF BUILDING HEAT SOURCE CONTRACT PRIC.E OF WORK � <br /> � <br /> Eleclric Gas Other �- � ��,.� -1� / . , <br /> l'� 1 '� , — — — — <br /> WORK OESCRIPTION <br /> � � , . . . , -� . ,._ . . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OH fTEM NO. TVPE OF Fl7(TURE OR ITEM <br /> Toilet A/C-air handling units <br /> 6athlub Forced air system, <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Ki�chen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes wasber � Clothes dryer <br /> Waten c�ater Hange hood <br /> Sink(service/badmop/eta) _ Exhaust fan <br /> Backllow preventer Hea�pump <br /> Urinal Unit hcater <br /> Drinking Founlain _ Boiier <br /> Floor drain Refric�eration <br /> I _ Grease trap Woodstovc <br /> I = Roof drains — = Other = <br /> Other <br /> � — — — — <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily ihat I have read and examined this applicalion and know the same to be true and covact. All provisions ol laws and <br /> ordinaces governing Ihis type of work wil!be comp!;ed with whether specilied herein or not.The gran5ng of a permit dces not presume <br /> to give authority to violate or cancel the provision o(any other stale or local law regulatiny constructi�m or the peAormart;e of <br /> constmc a am aut onz byNre�c�ner of this property to pedorm the rk for which applkation is made and I comply with the <br /> S�a ontractors Law 1827`CW rmd 296.20D'M C. <br /> ( � _ ------ � �- �� <br /> Signat � ncr/ContrecmdAidhonz ��. e <br /> `�L <br />