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� P'ERMIT APPLICATION <br /> CITY OF EVERET7 PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT,WA 98201 <br /> � 425-257-8810- FAX 425-257-8857 - www.everettwa.org <br /> APNLICATIO S ARE ACCEPTED FROM B AM TC 4 PM �ti U'� // 'GY � <br /> SITE ADDRESS<<�t Fh 5 S ('ZII�� pARCEL TAl(�.D.p P�RMI # <br /> :3c�a3 w. c�s,Nr� /z0 c5 ��i/ - o`/ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADDRESS CITYILIP PHONE <br /> �� N� <br /> TENANT NAME CONTACT FOR PERMIT `/z�: P,�o�E �'S�� <br /> (�DNPr� � � <br /> � E•MAIL��_ <br /> �bRTkA�TOR �— <br /> lahti-`� �'1CLI�a C,r��'si2✓�tic�N / <br /> CONTR.LICENSE M ? _�Y• �'�� _ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �-�� _Eloctric _Gas___Olher � )^OU't7� — <br /> WORK DESCRIPTION , - r �rp Y�� �l�N�•� 5/�P 7 �/�� <br /> /Ns�r, u-- 3�_A �r �C:-�E - <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIxTURE OR IiEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilut _ A�C-air handling units <br /> BathWb _ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Walerheater <br /> Kitchen sink R disposal _ Gas fireplaco <br /> Dishwasher _ Gasran�o <br /> Cbthcs washer _ Cluthes dryer <br /> � Waler healer __ Renge hood <br /> Sink(service/barhnnp'etr..) _ Exhausl fan <br /> Backllow prevenicr __ Heal pump <br /> Urinal _ Unit heater <br /> Drinking Fount�in _ Boiler <br /> Floor drain _ Rofrigeralion <br /> -- Greasc Irap __ Waodslove <br /> Rool drains _ Olher <br /> Olher ._ . — — <br /> -- --- -- __ . <br /> I — -----.__ . <br /> I CITY OF EVEftETT LOCAL SALES TN(CODE IS�105 <br /> I — — <br /> ��. I hereby cerihly Ihal I have roaA and examined lhis application and know�he same to be lruQ and correct. All provisions of laws and <br /> '� ordinaces goveming Ihis type of work will be complied with whelher specilied herein or noL The grenling of a pormil does not presume <br /> � to give authority lo violate or cancel Ihe provision ol any olher stato or local law regulating consiruclion or�he pedormance ot <br /> wnstruciion. That I am aulhorized by tho owner ol this property lo perlorm Ihe work tor which�pplicalion is made and I comply with the <br /> '� Stale ,.onlractor Law�1 7 RCW and 2�6.200 WAC. <br /> i �-Mtin�, .' (1��' l�" ,1 7 n 7 <br /> � Siynaluro ol OwnedConlraclodAulhonze�d Agenl Dat <br /> I 11 V <br /> I _.._ . . . . .____ ___ . .. ._ .__ _____. _.... _. . <br />