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� . c � <br /> � PERMIT APPLICATION <br /> ,� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810–FAX 425-257-8857–www.evereriwa.or�� �` � Z�� <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM -DEBIT R CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I,D.N PERMIT N � �. <br /> � Ooy I !o �� G � <br /> LEGAL LOT NO. BLOCK TMCT <br /> DESC. <br /> OWNER ADDRESS CITYILP PHONE <br /> .57s P�pe�l,y $a���oas � <br /> TENANTNAME I �ONToe F�aP��T�� PH�N��' I—��21 <br /> 3 5 �iiev -i <br /> CONTRACTOR ADDRESS CITYILP PHONE <br /> Woc.FE NG4T �F�,SD1G / 1�321 'TYE STSE y 3(�O-7Q�1-�(p21 <br /> CONTR.LICENSE� Wo�.HF9(oL,OG �ONRO E� W� `�� r L <br /> USE OF BUILDING <br /> -' HEAT SOURCE I CONTRACT PRICE OF WORK <br /> M�� _Eledric _Gas_Olher <br /> WORK DESCRIPTION <br /> Inod►�y ��c�5hr� �►re sPn+�l��� sy�ewi �� rev�o�e� <br /> � �e�tawt : wve -t <br /> FLUMBING MECHANICAL <br /> N0. TVPE OF FI%TURE OR ITEM N0. TVPE OF fIX?URE OR ITEM <br /> Toilel A/C–air handling units <br /> u Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> � Shower Water heater <br /> Kitchen sink&disposal _ Gaslreplace <br /> Dishwasher _ Gas range � � <br /> � Clothes washer Clothes dryer � <br /> _, Laundry tray _ Range hood �7 5� <br /> Sink(service/bar/mopfetc.) __ Exhaust fan 'l I <br /> 9ackAow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> — Boiler <br /> _ Dnnking Fountain — r��+Q f <br /> Floor drain _ Refrigeration I <br /> _ Greasetr;p _ Woodslove i7 I �— �(�, <br /> Roof drains _ Other L– <br /> = other — �,e A(� <br /> — I <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS J1D6 <br /> I hereby ceritify lhat I have read and examined this applicalion and know the same to be true and cortecl. All provisions ot�aws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting ot a permit dces not presume <br /> to give authonty lo violale or cancel Ihe provision of any other fitate or Iowl law regulating constructian or the pedormance of <br /> constr ction.That I am authonzed by the owner o1 this property to pertorm the work for which application is made and I comply with the <br /> St C ntradors Law 18.27 RCW and 296200 WAC. <br /> n <br /> _ � <br /> Sig ture of OwnedContractoUAulhorized Agent Date , I <br /> `� <br />