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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEUAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8657—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEU FROM 8 AM TO 4 PM f J c. j-/,� --/D <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> i ,- . � ��l �� �- �o�� - oo� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> O ER ADDRESS CITYIZiP PHONE <br /> / / ,/� / <br /> :% IJHw,�= �Cr�� `G`C'�JS �7yG� ��✓C >.�� /'LC-i�'/� /�'g /�l�--Z�U '1J�`�-'�% <br /> TENANT NAME "� CONTACT FOR PERMIT PHONE���hJ� -;'��, �/ aC� <br /> , c. / �/�<t ����.,?. � I ,�• �Cf��//� E•MAIL -�t✓✓eL��k^;i.�-it�/'r,r. .��x <br /> �� T�� � AD^ , UT IZI� E ' <br /> /7 � <br /> �L!L`r /��. ��iii�� ��f' rS,��� ���4�,V �.'c� �Er .�i�t/ic:�-iJj � >�� %�J/� <br /> CON fLICF�N E#` n / - /�� 7e•�..sj���y <br /> ��I�`i�- .x l'�'7rC C �✓ ��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �„� / ���� S _Eleciric _Gas_Other �5�`�^ � <br /> � w 'L 7/ 7 '" '. <br /> WORK DESCRIPTIO <br /> ��� 7 �'��f'��' � .���� ,� �fr'��J r�'+� <br /> .�i:i r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TY?E OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Eathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler heater Range haod <br /> Sink (servicelbarlmop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founiain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap Woodstove_ <br /> _ Roof drains � Other _�s����� -' <br /> Other � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certi�y lhat I have read and examined lhis applic2tion and know ihe same to be true and correcl All provisions of laws and <br /> ordinances governing�his type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authorily lo violate or cancei the provision oi any other state or Iocai law regulating conslruction or the performance af <br /> constructipn.That i am authoriz d by the owner of this property to pertorm lhe work torwhich application is made and 1 comply with lhe <br /> State CO tractors 18.27 W and 296.200 WAC. <br /> � �� i� <br /> / .�.-.. ,/�'�>„ - .� <br /> Signatur of OwnedConiractor/Authorized Agent Date <br /> � <br />