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� <br /> FcRMIT APPLICATIvN <br /> CITY OF EVFRETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everetiwa.ory <br /> I APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PEkM1T p <br /> �1Z� (� ��. ��A 43� 3�Z�,� . . ��/ - no7 <br /> LEGAL LOT NO. BLGCK TRACT OR SUBDIVI51011# <br /> DESC.� <br /> OWNER ADDRESS CITYfZIP PHONE �� CO(� <br /> ( l�� / �J�i �'-` ( <br /> _�1c YL'\� 'S' �� l,�' �5 �7�-b •�fGCC� �,A ��Z�r7 w� <br /> TENANT NAME (` CONTACT FOR PERMIT PHONE Lp6 S'1\ –��t S <br /> � J L.�1/�"�Gl11LIn"f1✓� n <br /> f �C�%�rt� �C ��i �L ��1 �� E-MAIL L !;�Sj c�c-�r�-��aT«T: �� <br /> TRA OR D S —Z.`�fT/ P G <br /> � � 2)r (�• r�-Sa- -�� �_ ��oT�c-,,v� L�L ��'l �y �; � PycTr {7 �''� y���4fs�-�' L <br /> CONTR.LICENSE q r;1���,1 (l�� t ^ 1� ��,� " �P �Od ' L h <br /> C 1.:�t I L <br /> C <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK c� <br /> Eiectric Gas Other 'r <br /> WORK DESCRIPTION ���P r��,�/ ��c� U� �K�S SJn � �,tJ� � <br /> v � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXiURE OR ITEM NO. IYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backflow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain 8oiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify ihal I have read and ezamined this application and know the same to be irue and correct. All provisions of laws and <br /> ordinaces governing this type ot work will be complied wilh whelher specified herein oi not.The granting of a permit does nol presume <br /> to give autho� lo vio�ate or cancel the provision of any olher state or local law regulating construction or Ihe periormance of <br /> constructio hat I am authorized by the owner ot lhis property to pertorm the work tor which�pplication is made and I comply with the <br /> State Co acto w 18.2 C nd 296.200 WAC. <br /> . , G.��%�� I � 3� -�� <br /> Signature o(OwnedContracrodAuthonzed Agenl Date <br />