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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STPEET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> � �� � �j � APPL�CATIONS ARE C�CCEPTED FROA1 A AM TO 4 PM <br /> _ (:�1"'�i ' ;� � �' <br /> SITE ADDRE�S �� L �,�; (cz j ; ,i C J� I) PARCEL TAX I.D.# PERMI7 M � �^ �� <br /> r, � �. z L - I �,�L��`C��� _ <br /> LEGAL LOT NO. ALOCK TRACT OR SUBOIVISION JI — <br /> DESC <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONEj1( L/ 2 7 - ' �' <br /> I I ({l�'1C'I (;_ E-MAIL <br /> -aa�r�a�s�-•-:: � �c_ j-�� s,� g <br /> r�'�f 3ti cou��{���(u�, /�l 1`� ii�C� �-f� <br /> CONTR. LICENSEM / y � �r7 ' \' LI , �7 <br /> C• �. ( _ __ `('r2lll 2 __ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICF OF WORK <br /> � � C c� `" <br /> ��i�/l ��e"�L f.y.�----— I _Eloclric =Ga•,__Other ---� — 1 � - <br /> L1_ <br /> WO KDESCRIpTION � ` I �( '�'' L �' <br /> i � l � r .� r ( (1� !^ � � j f� C.� �-�).f �. i iil�\ 'S c� <br /> J <br /> J'�l � I �C� I 1 1( .—��— —/ -- — <br /> —�LUM 31NG MECHANICAL <br /> NO. TYPE OF FlXi JRE OR ITEM NO. TYPE Of FIXTURE OR ITEM I <br /> I ioilel NC --air handlinp unils <br /> l3alhlub Forced air systcros <br /> _ Lavalory(w:�sh basin) Gas piping <br /> Shuwer Watw heal�!r <br /> Kitchen sink 8 dis�k�sal ___ G2s fir�place � <br /> ___ Dishwasher Gasranc�e i <br /> ____ Clou�es washer Clothus dryer <br /> _ Watu hc:der Ranc�e hooA <br /> Sinl.(serv�cc/bar/mop'�tc.) _ [xhausl fan <br /> �a�:hflow previmlo.r _ Hoal pump I <br /> _ Urinal Uni�hcaler I <br /> Drmking Fountain Boiler <br /> floor Arain Relrigeralion <br /> Gre�sc Irap Woodsinvo <br /> Roof Arains Odier <br /> _— Olher-------..__._ . ___ <br /> CITY OF EVERETf LOCAL SALES TAl(COOE IS ]105 <br /> I heruby ceri4ly Ihat I havo read anA ozamin��d ttiis applicalion and know Iho same to be lruc and corrocL All provislons ol laws and <br /> orAmaces�oveming this type of work will be r.ompliud wilh wl�elher spocilied hr.rein or no�. Tho�ranling ot a permil doss nol preswno <br /> to give aulhonty lo violate or cancel Iha provision of eny other s�a�fi or local law reyulating consiruction or the perlorm ince of <br /> construc�ion. That I am aulhorired�p Ihe owner of II�jSropeAy lo perinrm Ihe work lor which appliwtion is made and �wmply wilh the <br /> � Slato Contractors Law 1827 RCW�nA 296200)N C. <br /> � -' �____ ����� / �� I � � � 1 <br /> C� ` <br /> � - , �na��wne Conlrac-�Aulhorizu '� / � D e <br /> i <br /> � - ---- .. __. . ...------ <br />