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FERMIT APPLICATIJN � <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 I Z - OG � fj� <br /> SITE ADDRESS ��� PARCEL TAX I.D.# PERMIT N <br /> -z�;� � � ��a i�; n.i�:,.�p, _L�o s ia-o c,a. <br /> LEGA� LOT NU. BLOCK TRACT <br /> DESC. <br /> OWNF.R ADDRESS CITY2IP PHONE <br /> j D -� G�J �s�-f i�7J /G�� C�/-C/1C/7r G.�s� c� � '`/ <br /> . <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> .O'���fiLAyq-r'�+- --- �,��or - yar S7 37��� — <br /> CONTRACTOR��i � j � ADURESS, CITYIZIP PHONE ..,��r� <br /> / ' '�dn�Gtilr-/[Fj Gd/ Cfzl v A�.� ,!�(Av�surc i��f��' <br /> CONTR.LICENSEM������C „y�SNU ' y/tZ/� } PjL07 <br /> 7 / <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'J j!�/"l/�I/� _Electric _Gas_Olhor ��J � <br /> WORKDESCRIPTION ������q�C ��G/��J�`S' <br /> � <br /> PL�JMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIxTURE OR ITEM <br /> T�ilet A/C-air handling uni�s <br /> Balhtub Forcod air systams <br /> _ Lavalory(wash basin) Gas piping <br /> Shower 1 7 Waler heater <br /> Kilchen sink 8 disposal �/ _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clolbes washer Clothes drycr <br /> Waterhealer Rango hood <br /> s_ Sink(servicclbadmop/utc.) _ Exhaust�an <br /> Backllow preventer Heal pump <br /> Urinal _ Unit heater <br /> Drinking Fountain __ 9oil�r <br /> Floor drain Relrigoralion <br /> � Grease Irap _ Woodstovo <br /> Roof drains Olher _ <br /> Olhor <br /> CITY OF EVERETT LOCAI SALES TAJ(CODE IS 7105 <br /> I hereby ceritify thal I have rEiad and examined Ihis application and know Ihe same to he Irue and correcl. All provisicns ol laws�nd <br /> ordinaces�overning diis typ��of work will be complied with whelher specilied horoin or not.Th�granfing of a pormit doas not presume <br /> to give au�horily to violatn or canoel lh�provision ol any other slale or lor,al law regulaling cons�ruclion or the peAormance ol <br /> conslruction.Thal I am aulhurizCd by�he nwner o(Ihis property to perform the vrork lor which application Is made and I comply wi�h lhe <br /> Stale Conlraclors Law 10.27 HCW and 2J6.200 WAC. <br /> ���_- /z -7- a� <br /> Signature n(OwneriCon clor/Aathonzed Agrnt Dale � <br /> �--- I <br /> �. . _--------�-------. . .__----------- ------ -- <br />