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PERMIT APPLlCATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320� 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 I <br /> SITE ADDRESS �/ PARCEL TAX I.D.p � PER IT p <br /> �� /j �/1 .!� .J'/[.-Ei [n� � (r��t � �� I �'�J�''C�� I <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION U <br /> �ESC. <br /> OWNtR AD[1RESS CITYlZIP PHONE <br /> ( ll�/��(/ C l�l/�! ��� r c- <br /> TENANT NAME CONTACT FOR PERMIT PHONE ,�F, r-�!�p lJ� _ <br /> vi�t �/E�t 1�[" Cf?J 17r�) �E{",c %I.t,���) ,�!/J�7`/! �l—� E.�A�� o�TN� 58 C� /�a� , '� <br /> I.ONTRACTOR -�6 �;TfY/ <br /> CONTR.LICENSE k 1 I <br /> �`�-'�'�—��7}F��Lc' l'Z O ?C�!�� � <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE�OF WORK <br /> \ / Cti <br /> _Eleciric x Gas_Other I � .J ��r j! � <br /> WORK DESCRIPTION � <br /> ._/ � - � �� - � <br /> /��Ucr�-- ��1. - ' < .. � , : � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> _ Tnilct NC -air handling units <br /> _ Ba1hW6 Forcedairsystems / I <br /> _ Lavatory(wash basin) Gas piping / I <br /> Shnwer Watcn c�.lcr � <br /> _ Kitr.hen sinY.8 Aisposal Gas lireplace `„ <br /> _ Oishwasher Gas range .S u-� <br /> Clr�ihes washer Clothes dryer ��n <br /> _ Water healer Rango hood <br /> _ Sink(servicePoaNmop/etc.) .� Exhaust(an / <br /> BackOow preveNer _ Heat pump <br /> Urinal Unit hcater <br /> _ Drinkinc� Fountain Boiler <br /> _ Floor drain Refric�cration <br /> Grcaso Irap Woods�ove <br /> Rool drains Othor ' <br /> Other i/ X (/� I <br /> il -- - -- --�--- --- — � �f C ✓ A�� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS f05 <br /> I heroby cerilily Ihal I have read and examinud this applica�ion and know tho same lo e�rue and correct. All provisions ol laws and � <br /> ordinaces govnmin�Ous typo ol work w�ll be complied wifh whothor specilied herein r nol. 1 ho granling of a permit does not presume � <br /> lo�ivn authority to violate or cancel the provision ol any other slato or local law re ilating construction or Ihe periormanco ol � <br /> conslruclion. tal I am aulhorimd by Ihe owner ol lhis property lo perlorm Ihe w k I r which applicalion is maJe and I comply wilh the <br /> State Conlrac o;s�aw 1d.27 RCW and 296.200 WAC. ,.�� <br /> , 1�'� � �c.c. � �1 . <br /> Siynt�luro o Ownr,dConlractor/Authonzed Ac�ent "'" Dato�— �/ <br /> I . .. . . . . .. . . . _ . . _.__ _..------------�--------- ---------_._`--� <br />