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• 0 <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 ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> tvZ 5--;20 V-Clett Ake I /?t LA =b 13 <br /> LEGA$ LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> a `,el g &Aber2g 20 1`t�Soc / �ecefY k� ?r-20/ 6-0z0.2 -9c <br /> TENANT NAME C NTAI±T FOR PERM T PHONGa 267---L n:3 <br /> P CLC c74/64 er <br /> E-MAIL daf LLSL/t(i /1/.COTh <br /> CONTRACTOR�, /l7e ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE#W <br /> USE OF BUILDING HEAT SOURCE CONTRACTr7PRICE OF WORK <br /> rx _Electric X Gas Other 4�S / 000 <br /> WORK DESCRIPTION�/_/" I c <br /> , <br /> CCII(Gj 9 aO rAlerrf. 3 ie ,6ed:cow- rrciAta(/,s‘ a <br /> ,�i a f 4 c Oo 1 C.(„O ci41I`s , 7j re. f U-C c /\ tj SflccCfu'0 . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 1 )( Toilet A/C—air handling units ' <br /> / Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> /% Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains / -( Other d€c , nj <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State C 'actors w .27 R W and 296.200 WAC. <br /> gnature of 0 r/Co ract, 1sCugorized Agent Iate <br />