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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <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 /> SITE ADDRESS 6 t � PARCEL TAX I.D.# PERMI7 p <br /> �G _ �— --S � , c c�� c , < < � <br /> LEGAL LOT N0. BLOCK TRACT OR SUBOIVISION N <br /> DESC <br /> OWNER � ADDRESS CI?YIZIP PHONE <br /> �✓��t � /c i !� �l`— /i�� '�S� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �� ,�;��c y� <br /> �� U, e ��— ��--�— <br /> CONTR. LfCENSE p <br /> USE OF BUILDING // HEAT SOURCE CONTRACT PRICE OF WORK <br /> c�„�' \ , _Eloclric _Gos_Olher <br /> WORK DESCRIPTION � <br /> S;vt c �� ��'-w.- .`JC,�l ro o/Lt ��E' �vl � <br /> -- �� ��� f -- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilr.t A/C—air handhng unils <br /> __ CiatMub Forcod air syslems <br /> __ Lavalury (wash basin) Gas piping <br /> Showor Wator hoater <br /> _ Kitchr,n sink 8 disposal _ Gas fireplac� <br /> _ DISIIW7SI1Qf Gas�angc <br /> . Clo�hos wash�r _� Clolhes dryur <br /> _ Wa�or haater _ Rango hood <br /> _ SmM p�orvicelbadmnp/f�ic.) _� Exhausl fan <br /> _ Bachllow preventer Hoat pump <br /> Urinal Uni�healor <br /> Drinkm9 Founlain Boiler <br /> _ Floor driin Relrigaration <br /> _. Greasr. lrap Woodstove <br /> Rool drains Other <br /> Olhcr <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 5106 <br /> I hcreby ccrilily Uiat I havc rcad and ozamincd Ih;s appbcalion anA know Qio same to be Irue and correcl. All provislons of laws and <br /> ordinaces yovemin�ihis lype of work will be complisd with whelhor spacifiad herein or noL The granting ul n permil doos not presume <br /> lo[Jive autho�ily to violate or cancel lho provision ol any olh�r slab or loc�l law re�ulaling conslruclion or the perlormance o( <br /> consirur,lion. That I�m aulhorized by Ihe ownor ol lhis propeMy lo{'ertorm Ihe work tor which applicatlon is made and I comply with ihe <br /> Sta1c+Contractms L�w 78.27 RCW anA 29G.200 WAC. <br /> • � /, � <br /> �� < / - y-o <br /> Signalur of Ownerl onlracf horized Aganl'� Dalo <br /> i <br /> // J <br />