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: <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, VJA 98201 � <br /> 425-257-8810— FAX 425-257-R857 —www.everettwa.org i <br /> APPLICATIONS ARE ACCEPTE7 FROM 8 AM TO 4 PM f I <br /> �/C�P(-��-��/� <br /> SITE ADDRES Y PARCEL TAX LU.# D�t760�p�6co��P�RM�T t? I <br /> LEGAL ��0. � ��0 O`C�K�-� TR TORSUBDIVISION# ' ����^� � I <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> !%-���1 i � 1Z V"l ��� � 5 � 5�1 �� ��� . ��1� � � LJr3- 2o�,J�c�. 2 <br /> TENANT NA�AI� CONTACT POR PER IT PHONE C.�2S .b � �j S I 1 <br /> ��V'� \`_^ti- /1/ �� I V'{"�1' v �'4 1 • '1���� E-MAILL4MCr'Si l�'�/.1/�� <br /> TRA R r� c -� (�ADDRE t^ IiY21P{� /, � <br /> �'� I�s� �'W�� �'��``'�L'T `C�'1. �l( C' 1 IO__. � UD�rL �1 {�G 1..�`Z'S Y t� � b <br /> �.� <br /> CONTR.LICENSE fJ Ti,��-Y 1�(';('��'L^ ` , �� � I � <br /> C' �L/l `��b 1J <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK T <br /> Electric Gas Olher � • Z��, j� <br /> WORK DESCRIPTION ..-• + 4 <br /> /�� (� ^C�vv l�e_�,p .1✓� Sl.�cwt ��ti ��1'L"� 't- <br /> \ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas pipiny <br /> Shower Waler healer <br /> Kilchen si�ik&disposal Gas tireplace <br /> Dishwasher Gas range <br /> Clolhes washcr Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/b�dmop/elc.) Exhausl fan <br /> Backflow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler � <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> I hereby ceritify that 1 have read and examined lhis application and know the same lo be true and correcl All provisions of laws and <br /> ordinaces goveming lhis rype of work will be complied with whether specified herein or not.The granling of a permil does not presume <br /> to give aulhority t iolate or cancel 1he provision o(any other slate or local law regulatinr construction or the periormance of i <br /> conslruclion.T t I am authonzed by the ow o(Ihis propeAy to periorm the work for which applicalion is made and I comply with lhe � <br /> Stale Contr ors Law W and .200 WAC. I <br /> y � <br /> 7 � i <br /> Sign ure ol OwnedContractor/Authonzed Agent Date ' <br /> �_._— —i <br />