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PERMIT APPLICATION <br /> CITY OF EVERETT RERMIT SEFtVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 42�-257-d810- FAX 425-257-8857 - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS } PARCEL TAX I.D,p I pF�RM1T M <br /> /' � /_� � a�— �=�'� ��� 7/� ' �'�'�' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADDRESS CITV/ZIP PHONE <br /> / �l� I 1 r /l1 (� <br /> i1'�/ .'� .�`�/ �� �� ./i� /���r L��.�� 1 /`Xl���/� � .._� %J!-��7 <br /> TENANT NAM�� CONTACT FOR P MIT PHONE . <br /> E�MPIL <br /> y., �-� 3 � ��y. <br /> ��— i <br /> CONTR.LICENSE N <br /> USE OF BUILDING — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas O�her <br /> WORK DESCRIPTION <br /> " 7 . � — _/ v •' �� �_ /� � �/ <br /> I�_r_�_�� (�(v\��.I_ 4-]/� U ��.0/ <br /> ���� ( � ' ;�i... . � > ���������� �'��/�� � <br /> PLUMBING ' MECHANICAI <br /> NO. TYPE OF FI%TURE OR ITEM NO. TVPE OF FI%TURE OR ITEM <br /> Toilnt A/C- air handling units <br /> �athlub Forced air systams <br /> __. Lavalory(wash b2sin) Gas piping <br /> Showm Waton c��a�a <br /> _ Kilchon sink 8 dispos�l _ Gas lireplace <br /> __ Dishwasher __ Gas range <br /> _ Clothos washor _ Clolhes dryor <br /> Water hoater __ Ranpo hood <br /> _ Sink (service/badmop ota) Exhaust fan <br /> __ Oackllow proven�er Heal pump <br /> Urinal Unil heator <br /> __ Drinkin9 Founlain Boiler <br /> _ Floor drain Relri�eration <br /> _ Grease Irap Woodstovn <br /> Rool drainc OQie� <br /> O�har <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby corilily Ihat I have reaA anA ez:,mined Ilus applicalion anA know Ihe samo to be true and correct. All provisions ul laws and <br /> ordinaces yovnrning�his type of work wdl be comphed wilh whn�her specifiod hervin or nut.The granGng of a permil does nol presume <br /> lo yive authorily lo violatr.or cancel Ihe provision of any olher stale or local law rec�ulating construction or the pertormanco of <br /> cunsiruclion. That I am aulhurired by the owner uf�his property to pariorm ihe work lor which npplication is made and I comply with the <br /> Slate Conlractors Law 1B.'l7 RCW and 2�J6.200 WAC. <br /> laaoa <br /> Siynalure of OwnedContraclodAulhoriz�d Agent D t� <br /> � .�� <br />� � _ ___ <br />