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_ j " <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PER'MIT SERVICES <br /> 3200 CEDAR STREET, EVEF'ETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereUwa.org <br /> APPLICATIONS ARE ACCEPTED F�QOM 8 AM TO 4 PM <br /> SITE ADDRESS �'����' PARCEL TAX I.D.N PERMIT N <br /> '�c,� f�•�, �ASi�la 2�� [�OG�o-U57 <br /> LEGAL LOTNO. BLOCN TRACT <br /> DESC. <br /> OWNER AOORESS CITY2IP PHONE <br /> Q_n� ifJC <br /> TENANTNAME NTACTFOR PERMR PHONE <br /> ���. ir�c• ��T� �� ��s l�� �(2�. ��t --2�s 9�l <br /> CONTRACTOR ( AUDRESS CITV/ZIP PHONE <br /> CIFR-SC <br /> CONTR.LICENSE N <br /> USE OF BUILOIN6 I HEAT SOURCE CONTRACT PRICE OF WORK <br /> 0�1�1/� —Eleciric —_-Gas._9lher 2 QCA <br /> { <br /> WORK OESCRIPTION <br /> I?�F«ui_f= ��>�A-rc_M r1F i-�GC <br /> — — PLUMBING MECHANICAL <br /> NO. TYPE OF FI7(TURE OR ITEM NO. TYPE OF FI%TURE OR fTEM <br /> Toilel _ AIC-air handling units <br /> Bathtub _ Forcod air systems <br /> lavatory(wasl�basin) _ Gas piping <br /> Showor _ W�ter healer <br /> Kilchen sink 8 disposal _ Gas fireplaco <br /> Dishwashar _ Gasranpo <br /> Clothos washar _ Clolhes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/otc.) _ Exhausl fan <br /> Backllow proventor _ Hoat pump <br /> Urinal _ Unit hcaler <br /> Drinking Fountain _ Boilor <br /> Floordrain __ Reingeretinn <br /> Greaso Irap _ Woodstove <br /> Roof drain:: _ Olhor . <br /> Olher---_----.—_ — <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS 1105 <br /> I hareby ceritify thal I havo read and examined ihis epplicalion and know lhe same�o be true and correct. All provisions ol laws and <br /> ordinaces govorNng this lypo ol work will be compliud wilh wholhor spQcified herein or nol.The granting ol e permit does not presume <br /> to give aulhority to violalo or cancol tha provision of any othor state or local law regulating wnstruction or lhe pedormance of <br /> consiruclion.Thal I am authorized by tho owner of this proparty to peAorm tho work lor which application is made and 1 comply wilh lhe <br /> Sta Contraclors Law 8 2I RCW a d 296.200 WAC. <br /> ,(1n , h � �:'1/,r„�� ��/';.��' <br /> ignature of OwnerlContractor/Authonzed Agenl Dato ( � <br /> L <br />