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FcRMIT APPLICATIVN <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 AODRESS — C'� PARCEL TAX I.D.M PERMIT� <br /> s�n3 CU. (�}siNa 2� � . �S/:�3 <br /> LEGAL LOTNO. BLOCK TRACTORSUBDIVISIONN <br /> DESC. <br /> OWNER ADDRE33 CITY2IP PHONE <br /> � � � Iv � <br /> TENANT NAME CONTACT FOR PERMIT PHO E <br /> 8 6-zS <br /> Df� � ( I �E� �"` 130 /'�,.S�I � e.MaZ� 7 � <br /> a�r r✓G <br /> CO TR.LICENSE N <br /> USE OF BUILDING HEAT SOURC'c I CONTRACT PRICE OF WORK <br /> S 1 O/I..�fi C _Eloctric _Gas_Olher / o-4.p <br /> i <br /> WORK DESCRIPT�ON 5 � , �O �n ` / �T �_�� <br /> �� �S� �U I1 C� �h�.l.� O� 'f- �.�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF PI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilot A/C—air handling unils <br /> Balhtub Forced air systems <br /> Lavatory(wash oasin) _ Gas piping <br /> Shower Wator hoator <br /> Kilchon sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washcr Clolhes dryor <br /> Water hoaler Range hood <br /> Sink(servico/bar/moplatc.) Exhausllan <br /> Backflow preventer _ Heal pump <br /> Urinal Unit haater <br /> Drinking Founlain _ Boiler <br /> Floor rlrain Refrigeration <br /> Groasa�rap Woodstove <br /> i;oof drains Other <br /> Cilhor <br /> —I <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 7105 <br /> I hereby ceritify Ihat I havo road and oxamined this application and know tho samo to be lrue and correcl. All provisions oi laws end <br /> ordinaces governing Ihis lypo ot work will bo compliod wilh wholher spaci(ie�1 heroin or nol.The granting ol a permil does not presume <br /> lo give authorily to violato or cancol tha provision of any olher state or local law reguluting wnslrucUon or ihe pedormance ot <br /> conslruction. Thal I am aulhorized by lhe ner of Ihis propeAy to pedorm the work for which applicalion Is made and I compiy with lhe <br /> Stat Coniractors Law 1 7 CW d 200 WAC. <br /> �-�-�c' � � ��s��°e 1 <br /> Signature ot OwnedConiractor/Authorized Agenl Dato � L <br />