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PtRMIT APPLICATI(�N <br /> CITY OF EVERETT �'ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98�01 <br /> 425-257-8810— �AX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS E�° PARCEL TAX I.D.p I PERMIT p <br /> �� y log� S� SE q �3�„�b�, � �, � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS CIiY21P PHONF� „L6 <br /> �S[�ctin�- �.d, 'Ftnbw-�- Tr�e=t►�-f `�Ctts �-t��� <br /> TENANT NAME I CONTACT FOH PERMIT PNONE <br /> CONTRACTOR ACORESS CITY2IP PHONE <br /> CONTR.LICENSE p <br /> USE OF BUILDING I — HEAT SOURCF I CONTRACT PRICE OF WORK <br /> ��5����_ Eloclric Gas Olher <br /> WORK DESCRIPTION <br /> (Q.�1Ca.c.:�n� fa0�'e- <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%7URE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> __ Toilet A/C-air handling units <br /> _ Bathlub Forcod air syslems <br /> ___ LavaWry(wash basin) Gas piping <br /> Shov:er Wator healor <br /> __ Kilchen sink 8 disposal Gas(ireplaco i <br /> ___ Dishwasher Gas rango <br /> __ Clolhes washor Clothes dryar <br /> _. Waler healer Rango hood <br /> Sink (sarvicolbarhnop/ntc.) Exhausl tan <br /> _ DacAflow provenlnr Heal pump <br /> Urinal Unit heator <br /> Drinking Founlain Boiler <br /> _ Floor Jrain Rafrlgoralimi <br /> Grr,aso trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITV OF EVERETT LOCAL SALES TAl(CODE IS�705 <br /> I haraby cerilily Ihat I have read and examined lhis application and know Ihe same to be true and corcect. All provislons ol laws and <br /> ordinacns c�overnin9 ihis lypo ol work will bo compliod with whother spaciliod heroin or not. The grenling of a permit Aoes not presume <br /> lo qiw aulhority lo violat�or cancol Iho provision of any olhor slale or local law regulating construction or the peAormance of <br /> consUuction. Thal I am xuthorized by ihe owner of Ihis property�o pedorm�he work for which applica�ion Is made and I comply wilh�he <br /> Stalo� Vaclors Law 78.27 RCW and 29G200 WAC. <br /> � ' � ��� (C!-� <br /> Signa u Ow edContraclor/ uthon Agent ate <br />