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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 />� <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />ADDRESS <br />��1��� 7`; �L�S r��; <br />LOTNO. � BLOCK <br />PARCEL TA% I.D. p <br />C •:'i-% ��'�'�� c�CC�,� ��% <br />TRACT OR BUBDIVISION R <br />�I-6--� <br />ERMIT p <br />��� � I I 1)) ` <br />unncn "--"--- <br />fii /� ( K �1�17i I I/i-1 ���C 1.'i i/l '_�l ��r' /�)5_)c�'� 'i�b 7.�x''..t�7`(� <br />TENANTNAME I _CON7ACTFORPERMIT PHONE <br />i,; �� 1,� k,A4�'t //.I , �,,, ��j_L:�/G.�� <br />e-Ma� <br />C R � <br />!i-)i' .} �.iii �'//i)�-t_• '%�»C' /G L l�� �.'i..t� i:��r Gi.�. L �NN�tLC�li �c�� %7� ��.-�C�� <br />CONTH.LICENSEN I�l��'N7��fj��1�����-'Cy �I.�-?/ <br />USE OF BUILDING HEAT SOURCE CONTHACT PRICE OF WORK <br />I �. Eleclric . _ . Gas . .._ Othar -� � J � `� ' � C <br />/ <br />WORK DESCRIPTION <br />/ i /�� ��< r l .C7: i�7i�(/ j i [ [� �Y: (C �'LI��Nii ��f LC I / IJ 'J <br />v <br />T_( i�.� � li <�1/:'�C' ����i�tLi�(�f i�:n, J�%iL ,'»���\1 <br />r �'c %1%l�'.. <br />/�-i �ii! li j�,, ��lli� 1�-L/.':iii�'�/�i���f . <br />NO. � TYPE OF FIl(TURE OR ITEM <br />Toilel <br />Balhlub <br />Lavatory (wash basin) <br />Showar <br />Kdchon sink 8 disposal <br />D�shwasher <br />Clothes washar <br />Waler hoaler <br />Sink (scrvicoA�arhnop'elc.) <br />Onckllow pravontor <br />Urinal <br />Orinking Fountain <br />Flonr drain <br />Greasc Irap <br />fiool drains <br />OOicr <br />N0. � TVPE OF FIXTURE OR ITEM <br />A�C - air handling units <br />Forcod air sys�ems <br />Gas piping <br />Walon c�ator <br />Gas fireplace <br />Gas rangc <br />Clothos dryer <br />R�nga hood <br />E�hausl lan <br />Hcal pump <br />Unit hcatrzr <br />1 �iler <br />Nclrigorat�on <br />Woodstove <br />Olher, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cenlily that I have iead and e*amined Ihis apphcation and know 11m s�mo to bo Irue and correct. All pmvisions ol laws ond <br />ord�naces povnrning �his lypn ol work will be comphed wilh whelher specdmd herein or not. The granling ol a permit does not presumo <br />to pivo nuthoiity �o wolite cr cancel the provision ol nny Nher stato oi local law requlating conslniction or tho porlormanco ol <br />conslmct�on. Thal I am aulhorimd by Ihc owner oi Ihis propoAy to padorm the work lor which appl�cation is made and I comply with Ihe <br />SW�a Conimcto�s Law 1l1.27 RCW �d4PG.200 WAC <br />... � .. , �. . � � � . t � /'Y� <br />