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I f <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �' ' . '� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRE55 PARCEL TAX I.D.N PERMIT N <br /> 2�io ' 2 i zoseoo ,�9i_n-a� <br /> LEGA LOT NO. BLOCK TRACT OR BUBDIVISION/ <br /> DESC. <br /> OWNER ADOHESS CI 21P PMONE <br /> . , , �1 1�7 � <br /> TENANT NAME � I CONTACT FOR PERMIT PHONE <br /> E�MAIL <br /> �rYleYr.11dl '�1�� ��-C I�o�?�Cram�'�,�Ood �p (�s3)gS�-205� <br /> CONTR.LICENSE R t� r , �,,� a3z�i <br /> e M�R•q��qBD r•i1R <br /> USE OF BUILDINO I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleciric _Gas_Olher <br /> WORK DESCRIPTION p <br /> v'�? �� r�,�.lC � ��% �1C-��(ll. <br /> PLUM9ING MECHANICAL <br /> N0. TYPE OF Fl%TURE OR ITEM NO. TYPE OF FIl(TURE OH ITEM <br /> Toilet _ NC-air haMlinp units <br /> Bathtub Forced air cystems <br /> Lavatory(wash basin) Gas pipinp <br /> Shower Water heater - <br /> Kilchen sink 8 disposal Gas lireptace <br /> _ Dishwasher Gas range / <br /> _ Clolhes washcr Clothes dryer � <br /> __ Water heater Ranpe hoo � <br /> _ Sink(service/badmop/etc.) Exhaust la <br /> _ Backflow preventer _ Heal pump �� ' � <br /> Urinal Unit heater _\, <br /> _ Drinking Founlain Boiler ��1" <br /> _ Floor drain Relrigeration V <br /> = Grease�rap — Woodstove <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritdy Ihat I have read and examined ihis application and know Ihe same to be Irue and correcl. All provisions ol laws and <br /> ordinaces governing Ihis type of work will be complied with whelher specilied herein or not. The pranling of e permit does not presume <br /> lo give aulhority to violate or cancel the provision ol any othor slate or local law regulatinp construction or Ihe performance ol <br /> construction. Thal I am authorized by,the owner of lhty property to peAorm the work lor which epplication is made and I comply with the <br /> State Contractors 18 2I Fi nd 200 AC <br /> ��� ��� , <br /> �� .1 � �4 %� �' i <br /> ignature ol wneu ontractor; u�onzed gent ate � ,/ <br /> (L <br />