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� I <br /> I-ERMIT APPLICATIJN ' <br /> CITY OF EVERETT PERMIT iERVICES <br /> 32�',� CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88'i 0 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIpNS ARE�:CCEPTED FROM 8 AM TO 4 PM �Q � � -�r'_D� <br /> SITE ADORESS�a O✓ Cp/L3y /%�e PARCEL TAJ(I.D.ti PERMIT# <br /> �Cl - t <br /> LEGAL LOT NO. ' BI.00K TRACT OR SUBDIVISION tl <br /> GESC. � <br /> 01YNERf,:r�/-. U/ n��� F,Vi���i�iSGAOUR�S�_ �-O/,�� CITYIZIP PHONE <br /> �/ ' , <br /> ��c � TE /Z�JO C(/cf_E7�i y�� -1,7Z- SyJL-, <br /> TENANT NA�1E � CONTACT FOR PERMIT PHONE ./?.9 - 73 T- Q07,S <br /> ��C7.C�; ` � 7 � � . <br /> � L� J / C L�>'/ ����7.`� %A E•MAIL�iJ.V.L�5�7i�ZA�� 'L <br /> C NTR� ACTOR ADDRESS C1TY21P H NE � <br /> CONTR.LICENSE tl � <br /> USE OF BUILDItv, HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ����� � �`� �f�N _Eleclric _Gas_Olher ��}�IG1 — <br /> WORK�ESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> _ e������� Forced air systems <br /> _ Lavatory(wash basin) Gas pipinc� <br /> Shower Water healer <br /> Kitchen sink&disposal Gas lireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clolhes dryer <br /> _ Water heater Range hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> _ BackOow preventer Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> _ Floordrain Refric�erelion <br /> Greaso trap V�'oodstove <br /> = Roof drains =I Other_ <br /> Other <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined lhis application and know the same to be Irue and correcl All provisions of laws and I <br /> i ordinaces goveming this typo of work will be complicd wiRi whelher specilied herein or noL The granting o(a permit does nol presume <br /> to give authority to viotate or cancel the provision ol any other state or�ocal law regulating construction or tho periormance ot <br /> conslruction. Thal I am aulhorimd by the o�vn�(this property to perform Ihe�vork for which applic�lion is made and I comply wilh lhe <br /> Slale Conlractors Law 18 7 RCW and 2�JG,�00 WAC. <br /> j'�.� .�� �•2�---�- ;'�� /�- 0��; <br /> Signalure of OwnedConUactor/Ay�6nzed Agent Dato <br /> � �lL <br />