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PERMIT APPLICATIbId <br /> CITY OF EVERETT PERMIT SERVICES <br /> 425-257o8810D FAX 425 257E 857E www e e8ettwa.org /;��) � �C� D c� <br /> f <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TA7(I.D.N P RMIT M � <br /> � , � ,��� s= - J�- ,�f -� �o� - � �`� <br /> , <br /> LEGAL LOT N0. BLOCK TRACT � <br /> DESC. <br /> OWt1ER AODRESS CIT1"RIP PHONE ��� St��tN � <br /> i_�,�,., ( '; � Id i�.� k , i_ � c- US ly `-It'�' S-1 . N� " I U2 �tv�zsR <br /> TENANT NAME I CONTACT FOR PERMIT PIIONE <br /> lvC�, 7/-� ���/9 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.UCENSEN <br /> USE OF BUILDIN(3 I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electrlc _Gas Olher <br /> WORK DESCRIPTION <br /> ., � -�i , .' � <br /> �/�,� �� � �. ,��� �,�.��-( r��� . . �� -, <br /> 7`� l���'r������ �S <br /> _>. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilol NC-air handling units <br /> Bathlub Forred alr systems <br /> ---- Lavatory(wash basin) Gas piping <br /> Shower Walei ho�tar <br /> _ Ki�chen sink d dis�wsal Gas firoplace <br /> Dishwashm _ Gas ranye <br /> - Clolhos washor __ Clolhes dryor <br /> Waler he�ler _ Ranc�e hood <br /> ._ Sink �servir.olb:�rlmopielc.) _ Exhauslfan <br /> _ Backflow provonler __ Hoat pump <br /> Urinal _ Unit heator <br /> , �rinkin� Fountain _ Boiler <br /> Floor drain Relri�oration <br /> Grease Uap Woodslove <br /> Roof drains Other____ <br /> Othr.r — <br /> � CITY OF EVERETT LOCAL SALES TA%CODE IS J10S <br /> I h�reby cerili(y Iha�I have read and examined ihis�pplicalion and know Ihe same to be Irue and coner.t All provislons ol laws and <br /> nrdinaces governinp Ihis type ol work will be complied wllh whether sper.dmd horein or nol. The granling ol a pemiit does nol presume <br /> 6�give aulhorily to violate or cancel the provision ol any o�her slate or local law rayulating conslruclion or Ihe performance ol <br /> r,uns�rudion. 1h�t I am aulhorited by the owner of�his property lo perform Ihe work for whlch appllcation fs :nede and I comply with Ihe <br /> Slale Conl�ac�ors Law iH 27 RCW and 296.200 WAC. <br /> � �`�_ <br /> �'� Z ISI�� <br /> Signatu��/Con�Irac�odAulhorizad Agent e <br /> /� <br /> L <br />