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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CFDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 – FAX 425-257-8857 –www.evereltwa.org <br /> ��� �T� .����� �j� ,. APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS ��. L � �'�Z} � ��C l: �) PARCEL TAX I.D. # PERMIT M <br /> � 2 L l, �' "(.� � <br /> LEGAI. LOT NO. �LOCK TRACT OR SUBDIVISION ll <br /> DESC. <br /> OWNER Af7DRE5S CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONEJ�'� ���./ 2 z ' .� � <br /> I ' .L(L'�! C' ' E-MAIL <br /> �bRTkn ;��•. � :�c' �i r .c",; —A6bAE88 � <br /> I`+y j'S � ounifr/�(��u/� /�'1 ��1iilC ) 'rf� <br /> CONTR.LICENSE p '� <br /> i _ ' "L_�.Z �`� 1 � �' � �7�:�i 2 _ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � _[leclric _Gas_Othar �� ,� � �1 �r <br /> y/-,-�i�� bti'1e�el f'S � ---- <br /> WORK DESCRIPTION �'�r��'1 j1 Pc„ 7�L�( � � (,�\^.}' 1���� C rc -1, r C� i S'�I/�� (�. �- <br /> / <br /> � �) L(� ,f'1 �� — <br /> T PLUMBING MECHANICAL <br /> NO. TYPE OF fl%TUHE OR ITEM NO. TVPE nF FI%TURE OR ITEM <br /> � __ -.___-- — ' — ___ <br /> i . _ lailcl _ A/C -air hnnAling unils <br /> �;�p��i��� __ Forced �ir systr.ms <br /> _ Lavatory(w,ish basin) --- Gas pipinc� I <br /> Shower Watcr h�ater <br /> � Kilr,hen sink 8 dlsposal Gas lirt�placo <br /> __ Uishwashor _I Gas range <br /> Clolhes washer _ Cblh�s dryer <br /> Waler healor _ Ranyo hood , <br /> Sink (service/badmoplutc.) C-xhaust lan <br /> �ackflow preveNer Heat pump <br /> Urinal _ Unit heater <br /> Drinkinq Foun�am __ �oil�r <br /> Floor drain __ Relrigera�ion <br /> Greaso Irap Woodstovo <br /> Roof drains Other_ _ <br /> Other _ <br /> CITY OF EVERE�fT LOCAL SALE9 TA7(CODE IS J105 <br /> � � I hr.rc�by ccrilily Ihat I havu ro2d and oxaminod Ihis applicalion and knuw�he same to bo Iruo and correcL All provisions of laws and <br /> o«finacr,s�overning this lype ol work will bo compliod with whethm specilied herein or not.Tho granting ol a pormit doas nol pre^_ume <br /> �o gi��e authonty lo violalo or cancel Iho provision of any o�hor sla�e or local law rec�ulaling construGion or Iho pedormance ol <br /> construction. That I am authorizeA 6; Il,e owne�ol UN�j�roperty to peAorm lhe work lor which applic2lion is made and I comply wilh iho <br /> i Stale Contrar.lors Law 1D.27 RCW a�r d 296.20UJ�CC. <br /> �i' _--� <br /> (,—�� �`��- .. .,�_� =--� % �� f <br /> �. :,iyn:ituw ol Own�dConlracbr/Authonzed Agenl Date <br /> I <br />