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P�RMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-757-8810— 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 p <br /> 0 C�� 0 ', �q �30�.`' oC) I i'n�(U �l S <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION t! <br /> DESC. <br /> OWNER ADORESS CITYIZIP PHONL <br /> NC7UC DUI�G- NC-� �UFi�I I �-11 l�t�-0 t')u��c,�1�,Va��Av� Euc� vt>11 d,95 �10 l��ti `I <br /> TENANTNAME CONTACTFOR PERMIi PHONE <br /> ���,V IL.�C.'�� E-MAIL <br /> ONTRACT R A DRE I /ZIP PHONE <br /> CONTR.LICENSE q <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF INORK <br /> IU�� �Vc�ra�t,Uc'- > —Eledric _Gas_Other <br /> WORK DESCRIPTION <br /> �ZC,�� t«� c�- vu,vJ `�����Ml�� n �u <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel fVC–air handling units <br /> � BalhtuL- Forced air systems <br /> � Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> � Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrangc <br /> Z Cblhes washer Clo�hes dryer <br /> Waler heater Range hood <br /> � Sink(service/bar/mop/etc.) Exhausl(an <br /> Backllow preventer Heat pump <br /> Urinai Unil heater <br /> Drinking Fountain Boiler <br /> floor drain Re(rigeralion <br /> Grease lrap Woodslove <br /> Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read�nd examined this application and kno�v Ihe same lo be lrue and correcL All provisions of laws and <br /> ordinaces governinc�this rype of�vork will be complied wilh whelher specified herein or nol The granling o(a permil does nol presume <br /> to give aulhonty to violate or cancel Ihe provision of any olher slale or local law regulaling consWction or the performance of <br /> conslruclion.Thal I am authorized by lhe owner of this property lo periorm the work for which application is made and I comply wilh the <br /> Stale Contractors Law 10.27 RCW and 296.200 WAC. <br /> , �'�-- <br /> �� � /i � I[%r'i'� I D��=3 / l�'7 <br /> �Sign t r o wne Conlr todAuthorized Agent Dale <br />