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i � <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.everettwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM G � �"0� <br /> SITE ADDRESS PARCEL TAX I.D.N I PERMIT II <br /> Do� 6 2o a o M��SbS- �o <br /> L GA LOT N0. BLOCK 1'RACT OR SUBDIVISION K <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> SnID C-o t�r�; �M�/ %�=�% <br /> TENANT NAME CONTACT FOR PERMIT PHONE'�i O(�— .Z.� ' C�� <br /> �c��y,�, �Ec� 1���� E.���c��s <br /> D �� <br /> Mo2l.rk� M�a-''e�t/sut� P.�• �3ox �N- l�2:�,c �06 • �2�-�0� <br /> CONTR.LICENSE It �A <br /> J'4a2�FM9'�-9 �lL "� <br /> USE OF BUILDING HEAT SOURCE �ONTRACT PRiCE OF WORK <br /> �� �� <br /> �F�1 C� n _Electric _Gas_Olher � � <br /> WORK DESCRIPTION �jy�a�y�.ty �coo�'D/ �xN'4J�i fiQw� "{�� �'���"�� <br /> �2 �»(S i �� �,�c.i ..�uQ.�c lo l�Ooti G✓>�hF./2 % 'f�.� <br /> � l�oa . �,y��a�� ���,�'cr's, s�4N•l� N�r: ��..,,o � <br /> Lo�-4��i�T-vn.� Qo�K. <br /> PLUMDING MECHANICAL <br /> NO. TYPE OF FIXTURE OR I fEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet 1 NC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waterheater � <br /> Ki�chen sink 8 disposal _ Gas fireplace !� / <br /> Dishwasher _ Gas range n,�� <br /> Clothes washer _ Clothes dryer ��/ <br /> Waler heater Range hood <br /> Sink(service/bar/mop/elc.) 1� Exhaust fan <br /> Backllow prevenler _ Heat pump <br /> Urinal UNt heater 'i <br /> Drinking Fowitain _ Doiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodstova <br /> Root drains 1� Other M N►Cc-Jp �S/2 <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerili(y that I have read and eza ' ed lhis application and know lhe same lo be lrue and correcl. All provisions of laws and <br /> ordinaces govern �Ihis type of work w' be complied with whether speci(ied herein or nol.The granting o: a pertnit does not presume <br /> to ive aulhorit o violale or ca provision ol any other stale or bcal law regulating constniction or the performance of <br /> 9 Y <br /> conslruclion.�ia l am au ¢� y the o�m�r ol!his propeAy to perform lhe work for which applicalion is made and I comply with the <br /> Stal ontr br Law 18.27 an . C. <br /> v � �c� �p � <br /> SignaWre of OwnedC �IraclodAulhonzed NgeN Dale 'I <br /> Z <br /> � <br />