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PtRMIT APPLICATIUN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, lNA 98201 <br />425-25�-8810 - FAX 425-257-8857 - w�+v�.everett�.� a org <br />APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE A�DRESS PARCEL TAX I.D. fl PEfjM� �� <br />� � c�. . � ; �, . ;: �-a ' � � <br />LEGPL LOT NO. BLOCK TRACT OR SUB�IVISION p � � . . .... . - " � �_ � � <br />DESC. � . , � � � i � <br />OWNER ADDftE55 CITY/ZIP PHONF �Z`�_��-7_/�� <br />��ir�,l, 4- Z�`2�J I�_��� P�. ,.��. L Vc_re-� �'32L�R 4z:�-3y� ��$7� <br />TENANT NAME CONTACT FOR PERMIT PHONE �z� ,,7, l� j-�p t <br />1 1 ' ' l� (.'.J'��.11`v <br />E-MAIL <br />�bFF�A�Tb�- - AbTiRE��-- � v �� <br />CONTR.LICENSEp <br />USE OF RUILDING i <br />/ <br />�7c�� r,.� <br />%��j1 A -� .�. <br />iN��� F���l,� HEAT SOURCE CONTRACT PRICE OF WORK <br />�� <br />,�A�� �[leclnc _ Gas _ Olhcr --` --- <br />WORK �ESCRIPTION I 1 I i <br />� ���1:r�...i lL ('At�..i+��\\ �\C'�.n�_G. <br />_1 <br />q �/ / <br />L� ��� / (� •� <br />PLU�IBING <br />N0. � ' �= O'- FlXTURE OR ITE�1 - -- — NO. <br />IToilel <br />l— Dathlulr <br />i —= Lavatory (wash basin) <br />Shower <br />__ Kitchr.n sink 8 dis�wsal <br />__ Dishwasher <br />_ Clo�h�s washer <br />_ Wator hoater <br />Sink (scrvicmbarAnc�p/otc.) <br />DackOow prevenlor <br />� Urinal <br />I Urinkiny Founl�in <br />Flo�r drain <br />�. Grr,asc Ir2p <br />' Rool drains <br />Olher <br />MECHANICAL I <br />TYP° OF FIXTURE OR ITEM I <br />_ _ P.�C - air handhny units <br />_ Fora�d air �ystems <br />__ Gas piping <br />W ater hoalcr <br />Gas lirnplace <br />_� Gas ran�e <br />_ Cbthcs drycr <br />__ Ran�e nood <br />Erhaustfan <br />— -- Heal pump <br />Unit hra�er <br />Doiler <br />_ RFfnfleratioc <br />N'oodstove <br />qther <br />�. CITY OF':VERETt LOCA SALES TAX COUG IS 7t03 <br />�� I horeby crritily Ih�l I havo iaaA and uxamined IY�s appbcation and V.now th� ,: mo to be lrue and correcl All provisions of laws and <br />�� ordinaces c�overning lhis ly�re uf work witl he co�n(.�ied wiRi who�her specliod hornin ur nol. The yranling ol a permit d��os ��t presumo <br />to givo aulhority lo violate or cancr,l lhe ��,rovis�on o( any olher slale or local law regulating cons�ruclion o� "�e perfom� ,.3 of <br />construction. That I ani a-dhorized by Ihn owner uf ltis property to perlorm Iho work for Hhich applicalic �.��ado ana i co:nply with Ihe <br />State Conlraclors �aw-ij127 RCW and 296.: J7 WAC. /� <br />i <br />,� � / �-� _ ., <br />Signaturo ol Own . Conlraclor/ iorizr .y����ont y Date <br />-� If-------- � . <br />'L <br />� <br />