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, --- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,N/A 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM C -I��O p <br /> SITE AUDRESS n� � PARCEL TAX I.D.N -��RMIjjN� � / <br /> �OUj Gl, ��}�/r�l/ /J� pOd " 11Y �p <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER AUDRESS CITYIZIP PHONE <br /> (?��E� r� �� <br /> TENANT NAMt COMTACT FOR PERAIIT PHO E � � / <br /> � O�l /�� /� 2.Jc Y <br /> .3 /'1 ��ZSV'��Oi25k=f ��e�a�� J _ <br /> ULT'�MA-i"� /�"��117fl/�S LO� ST✓falC.T�oN� ISI,S S, LA� STickN�y DR .�L�JN^�ubaD;Nl� <br /> CONTR.LICENSE N I 'L I'��,�V�j R �� �106)`a 9g'�'��/ J <br /> V O` <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � /n/S���C ( � f p/.> > I _� Eloctdc _Gas__Other IvDO dOU _ I <br /> WORK�E3CRIPTION <br /> 'ry',�cJC K /,,1 5��c r� n �J Lf�"^io Py <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF F�XTURE OR ITEM <br /> Toilot AIC—air handling unils <br /> Balhlub Forced air syslerns <br /> Lavalory(n•ash basin) _ Gas piping <br /> Showar Water hoater <br /> Kitchon sink 8 disposal _ Gas tireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothos dryer <br /> Water hoaler _ Range hood <br /> Sink(servico/bar/mop/etc.) _ .-nausl fan <br /> BackOow preventor _ Heal pump <br /> Urinal Unit healer <br /> Drinkinc� Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Greaso trap _ Woodslove <br /> Rool drains Other_ <br /> Olher <br /> CITY OF EVERETT LOCAL SALE9 TAX CODE IS]10S <br /> I heroby ceritify thal I have roaA and oxamined this application and know the same lo be Irue and correct. All provisions of laws and <br /> ordinaces povnrning lhis lypo of work will be complied wilh whother specified herein or nol The granting of a permit does nol presume <br /> to givo authority lo violalo or cancnl the provision o(any othor state or lo�al law re{�ulating construction or lhe pedormance of <br /> conslruclion.That I am aulhonzoa by lhe owner of lhis property to peAorm tho work for which applicalion is made and I comp�y with the <br /> Stalo C nlreclors Law 18./2z R W and 96.200 WAC.p � <br /> - �y,�i-f� G�,�r-�"� ' dl%-L � <br /> Signature of OwnedConlraclorlAuthorized Agent Dato �'Z- <br />