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P�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, [VERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J . 3—p 9 <br /> SITEADDRESS 1 G WC."(AjOrE � PARCELTAXI.D.S o�a39i a o PERMITN <br /> C'vER�1i �U� 98z°I � � ° ° G CI— <br /> LEGAL LOT N0. � BLOCK TRACT OR SUB�IVISION N <br /> oesc. �,1-3'�} z . (�—o 0 <br /> OWNER Z� W LK s.4 m�� � �Kw Y UR�� YC L�rCITYR� W/1 /O ooE 1p� �1- 2� � <br /> �r c- . . ,r �; <br /> � '"' A � <br /> TENANT NAME �" CONTACT FOR PERMIT PHONE <br /> i � <br /> ��ZS��(, T�`iT 1� � AD � E-MAIL <br /> /n <br /> CONTR.LICENSE M !1 V(/ ��, r( <br /> ll � <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRIC'9E OF WORK <br /> _Electric _Gas_Olher `�'1 2,✓ � v <br /> WORK DESCRIPTION <br /> ���W,� vv Fl (, �,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel A/C—air handling unils <br /> Ballilub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Showcr Water heater <br /> Kilchen sinh&disposal Gas(ireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Walen c�aler Range hood <br /> ' Sink(servicelbar/mop/elc.) Exhausl fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Greaso trap Woudstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS b105 <br /> I hereby ceritify Ihal I have read and exanuned this application and know lhe same to be true and corrocL All provisions of laws and <br /> ordinaces c�oveming this type ol work�aill be complied wilh whelher spoci(ied herein or nol The granling of a permil does not presume <br /> to give aulhoriry to violale or cancel Ihe provision of any other slate or Iocal law regulaling conslruction or Ihe performance of <br /> conslruclion.JiS�I I ain authorized by Ihe owner ol this property lo peAorm ihe work for which appucation is made and I comply with lhe <br /> Slale Conlrai:lors Law if3.27 RCW t nd 29G.200 WAC. <br /> ���� ;%�����;1/ ��� J� � ��0� � p c�� <br /> S(pnatur�of wnedConlraclorlAuthorized Agent Date ,/ <br /> YZ <br />