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P�RMIT APPLICATI�N <br /> CITY OF EVERE'TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 4?.5-257-8810-FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT R <br /> 1� � � �+-1 (� M o� 0 3- o i 3 <br /> LEGA LOTNO. HLOCK' TRACT <br /> DESC. � � � <br /> OWNER � ADDRESS � CRY21P PHONE <br /> �� c \.�.. �l�nc� `»I�1�c�c1C:e� � .� �\�Pc�� �1�1 �L1.1 �5�� <br /> 7ENANTNAME � <br /> CONTAC FORPERMIT PHONE � <br /> '�e '�� �' ` � <br /> , <br /> CONTRACTOR� ADDRESS CITY 'ONo�E �Q �� <br /> :��^^".E;,,✓ lvll!-�1�ec���{ �Ioe �' -�t o <br /> CONTR.LICEWSE N � ��� <br /> USE OF UILDING� NEAT SOURCE COCN�C�T P��,E OF L,�� <br /> '�(X, �Electric _Gas Olher �y.� (,o-� <br /> WORK DESCRIPTION1 ^f, ^��� � e l <br /> � _1 �� <br /> LJ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM NO. 7YPE OF FO(7URE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhtub Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwaslier _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) � Exhaustfan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined this applicalion and know lhe same to be true and correct. All provisions ot laws and <br /> ordinaces governing lhis type of work will be complied with whelher specified herein or nol.The granting ot a pertnit does not presume <br /> to give aulhorily lo viola ancel the provision of any olher state or local taw regulating construction or the perfartnance of <br /> construction.Tha a orized by the owne f lhis property to eriortn the wctk for which ap�.�icaUon is m;ide and I comply wNh lhe <br /> Slate Contra s La 27 296 0 WAC. <br /> ,�- �� l <br /> Signature - wne ontractor uth zed Agent a e � <br /> � <br />