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; <br /> PERMIT APPLICATION <br /> CITY OF EVERETT F�ERMIT 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 /> �� ' i � � � ri .C��� �L�,��J����Jl"�`L!'>S �LX`i Z� <br /> lE LOT NO. BLOCK TRACT OR SUBDIVISION�I <br /> DESC. �'�j -1 /�� <br /> / <br /> ONMER ADDRESS CITY2IP PHONE <br /> � %f:LL"� <br /> )79i,� t���.--��'�o�rs //G-ii ir�o�f /1✓ �f� lz/ �v,�;,�t� ��:3i;i ��/%U <br /> TENANT NAME CONTACT FOR PERMIT pHpNE ��'(5.�.3:i y/j/ <br /> ii / <br /> �\ : ! �7�{ 'rQl �l1' 1//1 �j � /�Uqr�hrat��� <br /> --/ �Pi tL l�f;i7e' �,r�r.. E-MAIL //A'/r�xil�/.lr .✓� <br /> ���%l/f-�-�-fil�f'i/7<a��, f��l�L�X_'',�l'. L4`/)' . <br /> CONS�2.LICENSEi �� . <���`[�r'YZ$ �"j$S'' ���25 3.�'/Ui/ / <br /> ��i �-ETt�%4- �!����'i� <br /> USE OF BUIIDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric �- Gas Other �-'" �,��]� <br /> WORK DESCRIPTION <br /> f������ .'i;_, ���/�'-7'�JJ�� ��✓ ��G11�/�C� C Y_S <br /> i <br /> �/% ��i ��� _� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR I7EN NO. TYPE OF FIXTIlRE OR ITEM <br /> _ 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 /> _ Cbthes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust han <br /> _ Backflow preventer � Heat pump <br /> Urinal Unit heater <br /> Dnnkiq�Fountain . Boiler <br /> _ Floor drain Refigeration <br /> _ Grease trap Woodstove <br /> _ Roofdrains _ Otber r?�il�''�i; �/`„ i(' <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3705 <br /> I hereby certify that I have read and examined this application and know the same to be true and corred. All provisbns ot laws and <br /> ordinances goveming this rype of work will be complied with whether spacified herein or n�.The granting oT a permR dces not presume I <br /> to give authonty to violate or cancel the provision ot any other state or lor_al law regulating construction or the pertortnance of <br /> construdion.That I am authorized by the owner ot this property lo perform the work for which application is made and I comply wit6�the <br /> StaJeGoMrastors Law 18.27 RCW and 296.200 WAC. <br /> / <br /> (��'1 ,r �� ",i i, . /i�>f , i / ��f�� i— �; <br /> Sign9ture of ChvnedContradodAuthonzed Agent�� Date �/ <br /> Z <br />