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PERMIT APPLICATIOi� <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 /> APPL�CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �� O � �n' �r`� �`� ' � PARCEL TAX I.D.� PERMIT A^ l <br /> ( ' 'IC�> - f <br /> LEGA� LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> fJESC. <br /> OWNER ADORESS CITYIZIP PHGYE <br /> TENANT NAME CONTACT FOR PERMIT PHONE Z� ' � . <br /> � C .. �AIL <br /> Z.`bF7TIFT�Tb�–, u �$ :♦ t 0�� / — <br /> �, � �, � ,U ,(�j�X ti �-�� <br /> CONTR.LICENSE k �C�� !���-��I ���P �M �gn6� _ <br /> C <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /�� Eleclric ____Gr.s_Olhor <br /> �{"`'����Cl,l"L.�_ — <br /> WORK DESCRIPTION r ` � OO�� U�� <br /> t,,��e� t � auv�lty d��c�w�- -F o '� � `� <br /> , . . <br /> --,��; (���1� �-�-_C . <br /> . ' �LUM8ING , . . . • M�CHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM NO. T1'PE OF FIXTURE OR ITEM <br /> Toilr.t •� ' NC-air hnndling imils <br /> , --- �,��������� � ' � _ Forced air syslems <br /> Lavalory(wash basin� _ Gas piping <br /> Shnwcr Watnr healor <br /> Kilchen sink & dispusal _ Gas lireplace <br /> Dishwasher Gas range <br /> - --� Clothes w�sher __ Clolh�s dryer I <br /> Waler healr.r __ Ranc�e hood , <br /> .._—� Sink(servicr,�barlmo���uh�..l __ Exhausl(an I <br /> -- Backllow provenler _ Heat pump . <br /> Unnal _ Unit hea�er � <br /> Drinkin9 Founlnin ___ Boiler I <br /> I — Flour drain � Relrigeralion <br /> Grr.ase Irap Woodslove <br /> Roof drains Other <br /> , I — Olhr.r . __-. ..--------- - _ <br /> CITY OF EVERETi LOCAL SALES TAX CODE IS�70 i <br /> ' I h�mby cerilify thal I have r�ad anA examined ihis applica ion and 4.now Ihe same to I�e Uuo and correcl. All provisions of laws and <br /> Iordinaces<�ovr.rning Ihis typc of work will ho complioA with v:�ielher sneciliod hr,rein or noL The granling of a pnrmil does not presume I <br /> ilu yiva awlhurity to viulate or cancel Ihe provision of any olhcr 51a1e oi bcal law regulatiny consWction or�ho poAormance of 'I <br /> construclion. That I am aulhori.ed by the owner ul ihis property lo perlonn the work for which applica�ion is made 2nd I comply with thr, <br /> S�ate Contractors Law 7t1.2i RCW and '29fi200 WAC. I <br /> � � -� �- --s ���3�0 j I <br /> II�.l;�nalurc ol OwncdCoNraclou ulhonzod P.9on1 Dale , <br /> � ' 1 I <br /> �i I <br /> -. . _ . _-_—___.___" __ .- __ ___'_---. <br /> J <br />