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PERMIT /�PPIICATIGN <br /> CITY OF EVERETT F'ERMIT SERVICES <br /> 3200 CEDAR STREET, 1=VERETT. WA 98201 <br /> 425-257-8810 - FAX 425-2:;7-88F7 - www everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.M P RMIT M <br /> 'i/ -� 0 1 ���C��� (�(:C'� <br /> � • ,��. � j it_ . <br /> �EGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> D[SC <br /> OWNER AD�RESS CITY/21P PHONE <br /> � <br /> �:� i .' �' ��% ;' �C� � ,. i/ / ,��' i� Si :uJ /�il�'/i/�. (.ii_� ' `_'Ut <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> - �f�'��(:l /� E•MAIL ( �%.I: �`�c�' i�'.7�. <br /> �dATiF7G� �— <br /> CONTR.UCENSE M � �") L��� �- -? <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> --- <br /> [ler,�ric Gas_ Olher _ <br /> WORN DESCRIPTION i� � ; �°��� .� /', �,.� /� ��� � � I <br /> ---- ---- -PLUMBING— - — ------ --MECHANICAL <br /> NO. TYf E OF FI%T�IIR[OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> — _ _�_ __-_______._ .__ .-_ . _____ - <br /> 1 oJ<•I _ NC nir hanJliny untls <br /> l3alhtuh Foiced air syslems <br /> Lav:doiy(wash basin) Gas piping <br /> Shower Waler healei <br /> Kdr.hen sink 8 Jisposal _ Gas hieplace � <br /> _ Uishwasher Gas range I <br /> Clothes washer Cb�hes dryer <br /> Waler healer Range hood � <br /> Smk (scrviceNadrnopletc 1 [xhaust lan I <br /> E3ackllow preventcr Heat pump <br /> Unnal Unil heater <br /> Dnnkiny f ountain Doder <br /> Flooi drnin _ Refngerahon <br /> _ Grease trap Woodstove I <br /> Rool drams Other_ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES?AX CODE IS J106 <br /> I hereby certity ihat I hnve read and exannned Ilus applicahon end know Ihe same lo be Irue end correct. All provisions ol laws and <br /> ordinances governing this�ype of work wtll be wmplied with whelher specfieJ herein or not The granting of a permtl Aoes nol presume <br /> to gwe authonty lo vwlale or cancel Ihe prov�swn of any other sinte or local law reguialing construc6an or Ihe pertormance ol <br /> construc�wn 71iat I am euthon::aJ by ihe ownei ol lhis property to perform ihe work lor which appGcation is made nnd I comply�.vith�he <br /> State Coniraclois Lew 18 27 RCW and 296 200 WAC <br /> ' , /� - r'� . ., .� <br /> Signature ol OwnedConlf r Authonzed Agenl Date <br /> I � <br /> � . . . . ._ _...- � - --._ -- - - - -� - -- - ------ - �-- ' <br />