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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 />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. N PERMIT E <br />LLGAI LOT NO. BLOCK <br />OESC. T�R/ACT/lOR -SU1BD!M1O <br />7�rL ��$ <br />OWNER ADDRESS CITY2IP PHONE <br />`tl ✓c'I ({ ('fink. 3rcI fiok,+ih��. /i�/r. �i r'i00I `�3`)7--��zc� <br />TENANT <br />//NAME COt"TACT OR PERMIT J PHONEl�;1L,,-317_y•�•z-�O <br />I�. IJ�i�h ��I'iG l�{.1 t/ <br />E-MAIL <br />CONTflAC /� ADDRESS CITY.gIP PHONE <br />o,t I r� NCbnl� <br />3-)rl h`cytAve C_114e(ett <br />CONTA. <br />LICENSEE <br />� % ,T <br />USE OF BUILDING <br />NEAT SOURCE <br />CONTRACT PRICE OF WORK <br />�l /!l71G <br />�Elegric Gas_Other <br />) 0"" <br />WORK DMFIIPTIC" <br />T4R A"'I'T To "K T! OF A RItL a FA AN fxiTOG r ANDopjR OA CE Ix11CD ITL rQt lit A! A rELRCAL CLINK. <br />DETIRIOR 1M. PITfRIOR R <br />xxR TO DIQIAE 0/ AND R MTN !TW PART <br />OOlul TIOV TO ELECTRICAL SISTS01r GYP <br />AL AND rIII 1 <br />nRE-LIEF lAI T& AND K 5J°EPE5STE MMW A! <br />I100E 01*111' 10 ELECTRiCAI, AND R1RtlIG lW11'r. III <br />FIRE G n4llaC4RD, 11 A kWd w, PER <br />RF>N REII PMNDES RRt fMIGRATIGlS CE [CTRKN, FIRE -LIFE SVFTT, IIR[ Y'rTRfSlIW !YlTp1, ARp RI1CK 5TlTDt <br />D rtlDE1CATYW <br />TO of pDx DCSK AREA <br />SQ)ARf fEIIfAG[ OE AREA TO BE RDnrXIED • K 5 E <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR REM <br />— <br />Toilet <br />Bathtub <br />A,'Chardhng units <br />_ <br />Lavatory (wash basin) <br />__ <br />Forced air systems <br />Gas piping <br />_ <br />Shower <br />Kitchen sink 8 disposal <br />Waterlealer <br />Gas fireplace <br />Dishwasher <br />Clothes washer <br />Gas range <br />Clothes dryer <br />— <br />Water heater <br />_ _ <br />Range hood <br />_ <br />Sink (service/bar/mop/etc) <br />Exhaust tan <br />Backdow prevenler <br />_ <br />_ <br />Heal pump <br />Urinal <br />Unit heater <br />— <br />Fountain <br />_ <br />Boiler <br />FloorDrinking <br />drain <br />Grease <br />Grease Trap <br />_ <br />Retdgeralm <br />Woodslove <br />— <br />Roof drains <br />Other <br />Diller <br />--- <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cemify that I have read and examined this appbcalicn and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulaing construction or the performance of <br />rized by the owner of this property to perform the wort, for which application is made and I comply with the <br />Slate ConlrRCW and 296.200 WAC. <br />constructio4ertif <br />If - <br />Signature or/Authorized Agenl Dale <br />