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� — -- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SER�'ICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SI7E ADDRESS PARCEL TAX I.D.M PERFIIT M <br /> i,� a ,,v. •� .,•T,u� . � Q G7 c�,�.-f)[fJ <br /> LEGAL LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER ADDRESS CITY2IP PHONE /N�SI <br /> / C <br /> �.e O FN LO f��d ZO �8�� �m0 /h�f. �fld�� IiNI {'�����ii.o�l <br /> TENANT NAME CONTACT FOR PERMIT PHUNE <br /> CONTRACTOR ADDRES9 CITY2�P PHONE <br /> CONTR.LICENS'_'M <br /> USE OF BUILDING NEA f SOURCE CONTRACT I�RICE OF WORK <br /> EIecU�c Gas Olher <br /> WORK DESCRIPTION <br /> ���.�j/���' �h� odnK, <br /> PLUMBING � MECHANICAL <br /> N0. TVPE OF FI%TURE OR 11EM N0. TYPE OF FIXTURE OR IrEM <br /> Toile! NC-air handling units <br /> Bathtub Forcad air syslams <br /> Lavalory(wash basin) _ Gas plping <br /> Sh�wcr Wator heater <br /> Kilch�n sink 8 Jisposa! _ Gas firep!ace <br /> Dishwasher Gasrange <br /> Clothes washm Golhes dryer <br /> Water heatar Range hood <br /> Sink(service/badmop/elc.) Exhausl lan <br /> Backllow provantor _ Heat pump <br /> Urinal . Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Relrigeration <br /> Groase Irap _ Woodsrove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TNC CODE IS 7705 <br /> I hereby coritily that I have road and examined thls application and know Ihe same lo bo Iruo and cortecL All provisiuns o(laws and <br /> ordinacos c�oveming this type of work will be complied with whether specilied herein or not.'bo granting of e pertnil does nol presume <br /> to give aulnodty lo violate or cancol the provision ol any olher slale ar local law regulaling ccnstruction or lhe perfortnance of <br /> consWclion.That I am authorized by Ihe owner ollhis property lo peRorm Ihe work for which applicalion is mede and I comply wltf�lhe <br /> Slalo Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> o,� — �2 - Oy't. <br /> Sig�aturo o Owner/Contr�r, orized Agent ate �/� <br /> � <br />