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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-P810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATtONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.p PERMR It <br /> 226z �-�d � 9 ,2 OD I C"i-7G7- r,r:� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION R <br /> o�sa �zq _ 30 �f75— •� <br /> OWNER ADDRESS CfTY2iP PHONE <br /> .S'.S-� L��G�Pl7� GLG �(D/7 ST'`'f'�5lv. .�IT71.F�qd'/�I���li-Q7� <br /> 7ENANTNAME I CONTACTFORPEFMR ONE <br /> � �/� Z G, �� E•MAILA�I'�7`YrXJO/�/iJAPl7F4nW •N"1 <br /> ��(�(�!Z O�'1X�7k <br /> COHTR.UCENSEp <br /> �086���1 3�oi ��r4r.�g. �,�/9a�sy����aL� �B�� <br /> USE OF BUILDING HEAT SOURCE COHTRA PRICE OF WORK <br /> r'jl�� I _Clectric _Gas_Other I�j��. � <br /> WORK DESCRIPTION <br /> ,��c- � .Si.�-rs�e � ian� S�u�e� sr��� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR REM NO. TYPE OF Fl7(TURE OR fTEM <br /> Toilet NC—air handling uniLs <br /> Bathtub Forced air system, <br /> Lavatory(wash basin) Gas qping <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/elc.) [xhaust fan <br /> Backllow preventer lieat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boilor <br /> Floor drain Refrigeration <br /> Grease t�ap Woodslove <br /> Rool drains Other <br /> _ Other� _ �,�� <br /> Cf7Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that i have read and examined this application and know the same to be true and covect. All provisions ol laws and <br /> ordinaces goveming this type of work vnll be complied with whether specified herein or not.The granting o�a oemit does nol presume <br /> to give authonry to violate or cancal the provision ol any other state or local law regulating construction w the pertormance of <br /> constructi � nat I am auth 'ze by the owner ol this property to pertorm ihe work for which application i!;made and I comply with Ihe <br /> State tf . ors �1 B. and 296_200 WAC. <br /> Signature ol er/ ntractor/Aulhorized Agent � �te I <br /> -J <br />