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-; _ <br /> P'ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> i3 v ; ) (� r 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.1! PERMIT# <br /> 7 /�"� -. ; �. �, �,/.' �r � 2 � c �-► Z n O 3 3 o C� 1�0.3 �0 l� <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER �.ODRESS CIN21P PHONE <br /> �. ./ r $ '�•.�r�i T;�: � 1���� �t'fz � .SY� ��'�r w iT Z06�-�57-/dU <br /> TENANTNAME CONTACTF�Ot�PERMIT PHONE yZS � �S � <br /> ',j ' /'� �Cch s� �'c� E-MAIL <br /> .�/� 12� :-S� s./s��.... S �4o�G <br /> CONTR.L�CENSE N 7�Z � ?'�U� 5 � �/'�"'^•�r�� W"' <br /> USE OF�UILDING HEAT SOURCE CONTRACT PRICF OF WORK <br /> � _Eloclric _Gas_Oth�r— <br /> WORK DESCRIPTION o + <br /> < Yood' +� �j <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bativub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heator <br /> Kitchon sink 8 disposal Gas lireplace <br /> Dishwashor Gasrange <br /> Cbthes washer _ Clothes dryor <br /> Waterhoater Range hood <br /> Sink (servicc/bar/moplolc.) Ezhausl�an <br /> BackOow prevoNor Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boller <br /> Floor drain Refrigeralion <br /> Greaso trap Woodstove <br /> Roof drains Olher <br /> Olher <br /> � V' rr+ � �. c <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritily thal I have read and oxamined Ihis application and know Iha same ro be true and correct. All provisions ol laws and <br /> ordinaces o��erninc�Ihis typ�of work will be complied with whelher spocilied herein or nol.The granling of a permit does nol presume <br /> to give a iority to viol r can the provision of any other stato or local law regulating consWclion or Ihe pedormance ol <br /> conslruc n. hat I m uthorized b the nor of Ihis proporty to peAorm tho work for which app�ication Is made and I comply with the <br /> State C tr tor � 1 . 7 RC . �_ <br /> oy <br /> Signature of Ow ed lraclor orizo AgoM le <br />