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P�.�IVIIT APPLICATIG,J <br /> CITY OF E1/ERETT PERMIT SERVICES <br /> 32C0 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-ti�:G- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE ADDRESS PARCF.L TAX I.D.p I C PERMIT p / <br /> _,i : I � o� �._ �vv ,! 9K� _1 (71 ��J" (��r <br /> IEGAL LOT NO. � BLOCN iRACT OR SUBDIVISION M <br /> DCSC I <br /> OWNER ADDRESS CITYIZIP PHONE � <br /> Ltl.) �'(r0' � i <br /> ��� ������� \h�Kl �`�''= <br /> TENANT NAME CONTACT FOR PERMI� PHONE <br /> �`6FTRd�T6� _ — <br /> E-MAIL <br /> CONTR. LICENSE M /j``�� / f,, <br /> ( / — I <br /> _--__ ......._. .--_— '_ _ --- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK , <br /> Clecinc Gas Other <br /> WORK DESCRIPTION <br /> � i\ ,�_�.! ��,.v,_; �.S,,y (tisi �._-.c� <br /> �l <br /> PLUMBING MECHANICAL � <br /> NO. I TVPE OF FI%iURE OR ITEM N0. TYPE OF FU(TURE OR ITEM I <br /> __ I _ __ ___ ___ __ __ _—__—- —. .__- ---_— — —__—__ — I <br /> - -- I I odet --- �IC -an ' �ndling unds I <br /> 13alhtub Forced eu systems <br /> : avaloiy Iwash basinl _ Gas piping <br /> Shower Water hoatei <br /> Y,nchen sink E J�sposal Gas fiieplace <br /> f`�stiw�shei Gas range <br /> Cl�il;es washei _ Clolhes dryer <br /> Waler hea�ei __ Range hood I <br /> Sink (sciwCelbndmop�e�c 1 _ C:xhausl fan <br /> flackflow pieventer _.. Heal uump <br /> Unnal Und heater <br /> -- Unnkmy f ount�im _ Uoder <br /> I-1oor diain Reli�geralion <br /> __ Grease trap Woodstove <br /> Rool drains _ Other I <br /> Olher _ I <br /> CITV OF EVERETT LOCAL SALES TA%CpDE IS 7106 <br /> I hereby cerily thnt I have read and examined Ihis application and know tha same lo be�rue and correct All provisions of laws and <br />� ordmances governuig Ih�s type of wo�k will be compheA wdh whelhoi spe�afiud herem or not The granOng ol a permA does no�presume <br /> to give aulhor�ty to vwi�te or cancel Ihe piovision of Tny olher st�te or lo�al�aw regulaling cons�ruction or Ihe pertormance ol <br /> conshuclion Thal I ani authonTed by ihe owner uf this propeity lo peif:�m Ihe work for which epplicaUon is made and I comply with ihe <br /> Slale Conlracloi s Law 1� 77 RC W and 296 200 WAC . <br /> � <br /> �� �L"l�l�� ' -��/� �'� - I <br /> Signatuie ul Uwlrei�Conilar.� iiAulhoii7ed Agenl Dd�e <br /> I_ f <br />