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(� <br /> PERMIT APPLICATION ,�� l�j� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATiONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITF.ADDRESS PARCEL TAl(I.D.N PERMIT# <br /> l/4/ ;t eR� ,�,d. .SUZ� ��� � <br /> LEGA lOT NO. BLOCK TRACT OR SUBDIVISION Y <br /> DESC. <br /> ONMER ADDRESS CITY2IP PHONE <br /> yltl'6T7.JE� NGn�E $��f�s .CL.G //Gll Ar,e�v,eT�• E✓��iTlaJA <br /> TENANT NAME CONTACT F'O,RI P�ERMIT PHONE ?�p-y�3-0,2�f <br /> WESSf.,�J T50TopES L�-G I �1iAyNE WLG�2Af+�S E-MAIL=+��' �+�'�fx�eEP¢ ,J <br /> � IT9izm— „., <br /> Un11rm=TEO r�Ecr�. SNL �o,�X lys7 m�eysvru.E, Ws, y�7o 3roo bs7-��9 <br /> CONTR.LICENSE N <br /> UN�,Im.�zs o q3 h'�6 ,Ex. 5�f3��i <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Df f�C� _E�ectric �Gas_Otber /� 700 a d <br /> WORK DESCRIPTION <br /> EXTfi��,t� /G� S�c�K��,e ��s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. � TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air Systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Disbwashei Gas range � <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal . Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Retrigeration <br /> Grease irap � _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITV OF EYERETT LOCAI SALE$TAX CODE IS 3706 <br /> I hereby ceAify lhat I have read and examined this application and know the same to be ttue aad cortect. All provisiw�s of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.The granting of a pertnN does not p2sume <br /> to give authority to vidate or cancel the provision of any other s�ate or local law regulatirg construc�ian or Itx performance W <br /> wnstrudion.That I am authorized by the owner oi this property to pertorm the work for which epplicaRion is made and I compy wiM the <br /> State ontradors Law 18. 7 RCW and 296.200 WAC. <br /> . q � .� ' aa <br /> Si atur of OwnedCo iractor/Authonzed Agent Da e <br />