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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 -- FAX 425-257-8657 -www.everettwa.org <br /> ApPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT iF <br /> � (oc� -/k ���'c�TnW /9 ' (003 0102 9 �lUl �.3`�' <br /> LEGA LOT NO. BIOCK TRACT OR SUBDIVISION# <br /> DESC. — <br /> OWNER ADDRESS CITYIZIP PHONE <br /> L C'itiS� � �� HL�,J'r� Ni d„(;OI S� X�41 ��. ��PN1Tl.� (�:.Obl Ll �i - c6z� <br /> CONTACT FOIt PERMIT PHONE <br /> TENANTNAME I �'7'S 33�- l3b0 <br /> CL A2C//-1 ti'lN 21GE '7- 2uXC�1'� C1 �'�Y�Y'J E•MAIL 3�d ��'�� � � � <br /> CO TRACTO ADD E I IZI �,.��x�CGS'��o t_ I� �L' Cq�i <br /> CONTR.LICENSE# � {� n) FI N i <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> L e r-�tit E i� � i N L � R��-��Y �Eleciric ✓Gas_Other <br /> WORKDESCRIPTION M�,��� C��ih.{2 � <br /> C�roc.�ry �vrc w �-t�t-t �t.rV� c.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 7YPE OF FIXTURE OR ITEM <br /> Toiiet _ AIC-airhandlingunits <br /> BathWb _ Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> Kilchen sink R disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clo�hes washer _ Clolhes dryer <br /> Water heater _ Fanc�e hood , <br /> Sink(service/barlmop/etc.) _ Exhausl fan <br /> Backllow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> Drinking Fountain _ 6oiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 _ <br /> I hereby certify lhat I have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br /> ordinances governing lhis type of work will be complied with whelher speci(ed herein or not.The granting of a permit does not presume <br /> to give authonry to violate or cancel the provision of any other s�ate or local Iaw regulating consiruction or the performance ot <br /> consUuction.That I am aulhorized by lhe owner of lhis property to perform the work for which application is made and I wmply wi�h the <br /> �Sta�Contractors Law 18.27 RCW and 29�.200 WAC. <br /> � � ��n.._��. � T ��J I I � 3�'1 D I <br /> Signalure of OwnedContracrodAuthonzed Agent Date �,- <br /> / <br />