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PERMIT APPL�CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PE MI7# <br /> �� i� w . c��No �� � ���'n��.s' <br /> LEGA LOT NO. BLOCK TRACT OR SUBUIVI910N M <br /> DESC. <br /> OWNER ADDRE93 CITYlZIP PHONE <br /> co�u��Nr�y -��,r�s�- ��oc,� �a�o�s�nr �� �1/T�rR2m3 42�353 �133 <br /> TENANT NAME CONTACT FOR PENMIT PHON <br /> U�MnAU� i'(`1 TYI+rnlSrr `qc�L, � (f�Dt��5�1'.( �f25-�1- 14r1 <br /> e-Mna flE�0�15�.E�11-�LllltS <br /> a,rviz'� a r <br /> lt��v�t�2�xc en�r�w-P�.rs� tc�s9 w. v�u-,� w�bvr� p,� Mo�� ��, w,4 H , <br /> CONTR.LICENSE N t <br /> ttEN���rfl�t� Nn1 �/20�iz 9�Z75 4ts-3UJ-1 I► <br /> USE OF BUILDING HEAT SOUNCE CONTRACT PR�CE OF WORK <br /> Rr^pqt� 3�p I _Electric �Ges_Other I ��QQ�O <br /> WORK DESCRIPTION <br /> wstxl �� Nk� P� ►.m �:,�arn �- rr��- r� �,�e-v� v � �-�- <br /> PLUM8ING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TVPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathlub Forced air systems <br /> _ Leva�ory(wash basin) � Ges piping • <br /> Shower Water healor <br /> Kitchen sink 8 disposal Gas firepiace <br /> Disliwaslier Gas renge <br /> Clolhes washer Clothes dryer <br /> Walcr healer Range hood <br /> _ Sink(service/bar/mop/etc.) � Exhausl fan <br /> Oackflow preventer Heat pump <br /> Urinal Unit heater <br /> Urinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> _ Grease Irap Woodstove <br /> = Rool drains — �I Other�y�L FR/tK�Ul� h�DY1�1{� <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX C7DE IS J106 <br /> I hereby ceAi(y that I have read and examined Ihis npptication and kno�v Ihe same to be irue and correct. All provisions ol lawe and <br /> ordinances goveming Ihis type ol work will be complied wilh wheiher specified herein or not. The granting of e pertnil does not presume <br /> to grve aulhority to violale or cancel ihe provision ot any olher rtale or local law regulating construction or the performance of <br /> conslr tion. Thal am authorized by the owner ol this propeAV to perlorm Ihe work for which applicellon fs made and I comply with Ihe <br /> State onl GoJs�aw 18.7,Z RCW and 296200 WAC. �� <br /> ^ L��L�LL�_.�-- �� <br /> SignaWre of OwnedCon�racforlAuthorized Agen� Dete ( <br /> �z <br />