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, <br /> I <br /> P'�RMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C�DAR STREET, EVERETT, WA�8201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCE�TAX I.D.# PF�R/MIT# <br /> � � � a0d O � /S U'v_i - � � <br /> LEGA LOi NO. BLOC TRACT � <br /> DESC. <br /> �W . R /� ADDRESS CITY2IP PNONE <br /> ��4,'�t.,°tn�c�l.�n��n= 3�Z(o � �.J�. <br /> TENANi NAME �y—e M - CONTACT FOR PERMIT PHONE Z a�— <br /> 1 1 C ✓Y' <br /> � �_�-l��11 ° �.� �-�,�� . ro�P�erM� 3s�-.S�z3� <br /> CONTRACTQR � <br /> ADDRESS CITY2IP PHONE <br /> CUNTR.LICENSE# —�J� <br /> 1 � <br /> . <br /> //U��SE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ` �T—��'� � _Electric _Gas_Other �(' � O �— <br /> WORN,DESCRIP710N <br /> I � <br /> �.0 M/y`(�n.G� C� �'� TBZ. V�VIJI��a.� ��` v �� <br /> U <br /> PLUMBlNG MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEh7 NO. TYP[OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling unils <br /> Balhlub Forced air systems <br /> � Lavalory(wash basin) Gas piping <br /> _ Shower Waler heater <br /> __ Kitchen sink 8 dispocal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(servicelbadmop/etc.) Exhaust fan <br /> _ Backflow preventer Heal pump <br /> _ Urinal Unit healer <br /> Grinking Fountain Boiler <br /> � Floor dr in Refrigeration <br /> _ Grease lrap V��oodstove <br /> __ Roof drains Olher <br /> Olher — <br />, CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ccritify thal I have read and examined Uiis application and know the same to be true and correct. All provisions of laws anC <br /> ordinaces goveming this type of work will be complied with whelher specilied herein or not.Tho granting of a permil does nol presume <br />� to give aulhorily lo vioiate or cancei the provis�on of any other state or Iocal law regulating conslruclion or 1!�e pedormance of <br /> construction.Thal I am authorized by the owner ol lhis property to perform the work for which application is made and I comply with the <br /> Slate Conlrac W and 296.200 WAC. <br /> Signature of wnedContractodAulhonzed Agent Da e ' <br /> ___ _�,`� <br /> r- _ <br />