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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 i <br /> 425-257-8810- FAX 425-257-8857 -www.evereltwa.org i <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 9 _�g—�J <br /> —i— <br /> SITE Af)pRESS PARCEL TAX I.D.# PERMOM <br /> X <br /> � , ��) � , �' i� 1� ' / - <br /> LEGAL LOT NO. BLOCK TRACi OR SUBDIVISION p <br /> DESC. <br /> OWNER I ADDRE55 ( t CITY2IP PHONE ( i' � S <br /> .�J�`�'L�JI�'� � ICtI l 15 �Z. �U ( Q(1`t' ���\�' ���> �U� �-_ V('�P.�i `-� U� V i �4VS-`iFi � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E�h1AIL <br /> R � <br /> i �_�( i <br /> r� :-.� �.� <br /> ��� <br /> CONTR.LICENSE# <br /> � I ��<' D � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eloclric Gas Olher <br /> WORK DESCRIPTION <br /> /=^`�' u/',,�' '' `�l � <br /> PLUMBING MECHANICAL I <br /> N0. ,TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM I <br /> ��_ Toilcl � � ,� �.•�. _ A/C-air handling units � <br /> E3athlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Showcr _ Wa�erheater <br /> Kitr.hen sink 8 disposal _ Gas lireplace <br /> Dishwashcr ___ Gas rango <br /> Clothes washor _ Clolhes dryer <br /> Waler hoalcr __ Range hood <br /> Sink (service;badmopletc.) _ Exhausl fan <br /> �ackflow preventer _ Hea�pump <br /> Urinal _ Unil healer <br /> Drinking Founlain _ Boiler <br /> � Fbor drain -,�� . �� � _ Relrigeralion <br /> Greaso Irap _ Woodslove <br /> Rool drains �«��� <br /> Olhor — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I heroby corilify Ihat I have read and examined Ihis applicatioo and know iho same to be Irue and corcocl. All provisions of laws and <br /> ordinaces governing lhis typc o(work will be complicd with whelhcr specified horein or noL The granling ol a permit does nol presume <br /> lo give aulhority�o viola�o or canr,ul ihe provision o1 any other stale or loca�law rec�ulaling conslruction or ihe pedormance of <br /> construr,lion. Thal I am authorized by ihe owner o(Ihis property lo peAorm�he work(or which applicalion is mada and I comply wi�h lhe <br /> Slalr. Conlractors Law 1II.27 RCW and 29G.200�VAC. <br /> � � <br /> (: , , �J..1., � t . ���: ��.�� � --- � � ( (1-C` / <br /> Signaluio o�OwneriCon�raclor/Aulhoriled Ayont Date <br />