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P�RMIT APPLICATION <br /> � CITY OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-B810— 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 PERMIT <br /> I o W ����1D I��v - S o�651 D lolop Q '�0�- �(� <br /> IEGA LOT NO. BLOCN TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITV2IP PHONE <br /> �qVIL'R-r-✓Ft' �A�k Cd��oMitJ��MS 143t) WLp51►� �'V ��r'tr °I�2�} <br /> TENANT NAME CONTACT FOR PERIM'IT � " PHONE � (062 *v211 <br /> L�6ATA7��aT�' I J��IIG�'Y� F-���D�' ' ^'�`��•MAIL�JIMCd�JPNFYf4{1Rl�7S.daVf <br /> '�b � <br /> CONTR.UCENSE p <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> (,0��11'��Ni�m [Icc�ric ___Gas Otlier � L'S��� �� <br /> WORK DESCHIPTION ., <br /> f��E � ��E si�� � � t�l.a'� �uJ&�PF �a�rzs <br /> PLUMBINr, MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toile� � � ' • � � . __ NC'—air handling units � <br /> �alhtub � � � _ Forced air syslems <br /> Lavatory(wash basin) . Gas piping <br /> Shower _ � Water hea�er <br /> Kilchen sink 8 dispnsal _ _ Gas lireplace <br /> Dishwashcr ___, Gasrange <br /> Clothes washer Clo�hes dryer <br /> Water heaicr . _. Range hood <br /> Sink (scrvicc'barimop'etc.� __ Exhausl lan <br /> Backllow preventcr ,___ Heat pump <br /> Urinal _ Unit healer <br /> _ Drinking Founlain __ Boiler <br /> floordrain _ Relrigeration <br /> Grcasc trap _ Woodstove <br /> Roo�drains .__ Olher_ ______ <br /> -- Other --_ . ._.---�---- __ <br /> CITY OF EVEpETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined Uiis applicalion and know Ihe same lo ba irue and correct. All provisions of laws and <br /> ordinaces governing ihis type of work will bo complied with whether specihed herein or noL The granting of a permit does not piesume <br /> to give aulhority lo violate or cancel Ihe provision ol any olher stato or local law regulating construction or the perlormance of <br /> consiruction. That I am author¢ed by the owner ol lhis property to perform the work lor which applicztion is made and I comply with the <br /> SI Contractors Law 18.27 RCW and 296.200 WAC, ?jap'1 <br /> � Us 23 � 'I� <br /> � nat� e of O iev ontrector/Au�honzed Agenl ate <br />