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� P�.RMIT APPLICATILN <br /> I CITY OF EVERETT PERMIT SERVICES <br /> , 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> � <br /> � APPUC.4TIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBI7& CREDIT CARDS ARE NOT ACCEFTED <br /> ISITE ADDRESS <br /> PARCEL TAX I.O.# PERMIT# <br /> I �6�� h ro� _ J -G <br /> IEGA L01'NO. BLOCK iRACT <br /> DESC. <br /> 04V�ER AODRESS CITY2IP PHONE <br /> 7'ENANTNAME r.�A�Ag� jONTACTFORPERMIT <br /> PHONE <br /> Soe ��ojl T�iYHKI ) � �:Il� � So ,,06 �,3 � ' �t��6 <br /> CONTRACTOR ADDRESS CITY,21P PHONE I <br /> CON�fR.LICENSE#OMSCd7F'�F� ��TLt iG�..� 3� s+ �� ��� ��� / � .yz6 I <br /> �"` ; �r6 • 36�R <br /> USE OF BUILDING � �- HFAT SOURCE I <br /> n ( ��/�] CONTRACT PRICE OF WORK <br /> *�Si-.4tlR.f4fJ _Electric ✓ Gas_Other �3�.�C• '� I <br /> W�RK DESCRIPTION <br /> �1�,Jarir I�.t��,u�r+z11T wolxic.5 ; �N"�t2ton G.�A+-�s, iNSTn� W/1tk-I� eor��� . I <br /> r�Pr � Hd�o , I�kI���IN�r . r-�oo�z�N�, K�-r�uaN ��x�rvl�.c , I <br /> i <br /> IPLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IT[M NO. TYPE OF FI <br /> ,� XTURE OR ITEM <br /> _ Toilet _ q/C—air handlin units <br /> _ Bathtub _ Forced air syst s <br /> _ Lavatory(wash sin) Gas i i <br /> <�- Kit� enrsink disposal —� Waterheat <br /> Dish sh Gas firepla e <br /> Clothes asher _ Gas ranp!� <br /> Laun tr othes�dryer <br /> „_f_ Sin service r/mop/etc.) � R' hood <br /> �, B kflow preve r — E.Y st fan <br /> H t m <br /> I� Drinking Fountain \ _ nit hea P <br /> rloordrain \ _ Boiler <br /> Grease trap � Refngeratio <br /> Roof drains '✓Voodstove <br /> I = Other — Other <br /> __ CITYOF EVERE7T LOCAL SALES TAX CODE IS 3i05 <br /> I hereoy ceritify that I have read and exarnined this application and know the same to be true and correct. All provisions of laws and I <br /> erCinaces gocerning this type of work will be complied with�vhether specified herein or not. The granting of a permit does not presume <br /> to give authonty tn violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> constructicn. Thai I am authorized try the owner of this property to perform the work for which application is made and I comply with the <br /> Slate C�t ctors w 18. 7 RCW and,296.2U0 WAC. <br /> \ /( � <br /> � Sign ure of Owner,'ContractorLluthor,zed Agent /� �/Date � <br /> 'la <br /> � <br />