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PFRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25- '+810- FAX 425-257-8857-www.everettwa.org <br /> APPLICNTIONS ARE ACCEPI'ED FROM 8 AM TO 4 PM <br /> SITE AODRESS PARCLL TAX!.D.N PE MIT# <br /> J3t � h S l ' �... ,n-�/� �� ` �C��"S %�J7 � �J� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITYlZIP PHONE <br /> n Lc-r eh <br /> n�,�,u/ns !'„I�., _ tFl M ��I��.,, Cs9Sblc 4!6 7/S -/Flf� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR AODRESS CITV2IP PHONE <br /> CONTR.UCENSE N �� �('.� <br /> USE OF BUILDING HEAT SOURCE CONTRNCT PRICE OF WORK <br /> _Eloclric _Gas _Othor ���;'v r <br /> WORK DESCP�?TION `��,�` f, /�`2q`�,�C� �•� �� , <br /> C ;/ � <br /> � / . <br /> _. �,//_�� � <br /> PLUMBING•1 MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR IT[M <br /> /� Toilol __ A/C-air handliny units <br /> ��_ Balhlub __ Forcod alr systnms <br /> i�_ Lavalory(wash basin) __ Gas piping <br /> Slwwar ��_ Waler hoatm <br /> Kilchen sink 8 dis�wsal _ Gas fireplaco <br /> Dishwasher Gasrango <br /> � Ciolhes washor �._ Clolhes dryer <br /> � _ Walor ho�tur Rango hooA <br /> _ Sink(servicdb�r/mor�olc.) �_ Exhaust lan K L <br /> Backllow pwvontor Heat Nump <br /> Urinal Uni�heator <br /> Drinkinc� founlaln Boilor <br /> f luor drain Ralrifleration <br /> Grcase Irap _ Woodslove <br /> Rool drains Olhor <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J70S <br /> I hereby cerilily ihat I have rcad and ezamined Ihis appGca6on and hnow the same to be�rue and correct. All provisions of laws and <br /> ordinaces c�overniny Iliis type ol work will be compliod with whoUmr spocifiod heroin or no�.The gran�ing ol a permil does not presume <br /> to c�ivA aulhority to viola�c or canccl tho provision ol any olher slale or local law ro�ula�ing consWclion or ihe peAormance ol <br /> construclioa Tnal I am aidhrnizod by the owner ol lhis property lu porlorm the work lor which application is mado and I comply wilh Ihe <br /> Stalc Contr cturs Law 18.27 RCW and 2�J6200 WAC. <br /> `/ � .� <br /> 7l � - �C /��o <br /> �Ign�r I�ik f Ownc�dConirectodAuthonzed Agent ate � <br /> IZ <br />