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( � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 42&257-8857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 4 �I,3 -(7 7 <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT N <br /> �� % �- �;,,� -- �� , . �'�� �--� <br /> LEI:AL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE8S CITYIZIP PHONE <br /> TENANT NAME I CONTACT FOR PEflM1T PMONE <br /> �1 E 9//JiL'✓S /�t'���i �!'�f1Gif���3/� <br /> CON CTOR `�C� ,1 . I �(ADDRESS � CITY/LP PHONE � � � J ' <br /> �v�lili�d_�.�ual� ��r�h �� A,�.l���tiUl�c��. , �. ("L.'�jJ1�1 � �-�-' <br /> ,; . ,: , �,, y.��,� : <br /> CONTR.LICENSE/^t� �`,�M� c�c JG`' 11 � �. ' � ,. <br /> -0 �5 S r <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Elednc Gas Other �� � �� � ��, v <br /> WORK DESCRIPT QN �,�/ - fy_ <br /> �� �cc�tL,,,, /�'c,r (,tj ��r� i �. C.(..�.,.c.� �s u /�-� — � 3 <br /> L?� S� '�/" �J�;,;�aalloL s''�/-'✓�«� ��/:a.� ��.�( . � �y= /v���. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TVPE OF FIXNRE OR ITEM <br /> Toilet AIC-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basln) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 dlsposal Gas hreplace <br /> Dishwasher � Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Renge hood <br /> Sink(service/bar/mop/etc) _ Exhaust len <br /> BackAow preventer _ Heat pump <br /> Urinal Unit heater <br /> _ Dnnking Fountaln Boiler <br /> Floor drain � Refngeration <br /> Grease trep _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA)(COOE IS 7106 <br /> I hereby centdy that 1 have read and examined this application and know the seme to be true end cortecl. NI provisio�s of laws end <br /> ordmaces govemmg this type of work will be complied with whelher specifled herein or nol Thn granting of a permit dcea rrot presume <br /> ro give authonty ro violate or cancel the provision ol any other stete or laal law regulating construclion or the perfortnanta of <br /> wnstrudiun. That I em authorized by the owner ol this property lo peAorm the work for which applicalion is made and I comply with lhe <br /> State Contractors Law 1B 27 RCW and 296.200 WAC <br /> �- '. � ���� �_, -;�G�. ��%- G� �3- <br /> �gnaWre vm on ut onz gent ate <br />