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PERMIT APPLICATION <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 9 AM TO 4 PM / Z —S_O� <br /> SITE ADDRESS PARCEL TAX I.U.p PERMIT# <br /> ,-� ; w w.S�M� �1 � � o�sia_ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �r u K ra F ► � 1= � u � a 3 - � 3�2`� uw��� a� Ma�unile �1-a S-3�+4--c�, <br /> TENANT NAME CONTACT FOR PERMIT PHONE l <br /> I � I-e.V. .'v� ��``�IL E.MAIL��` �� U ^ ��L� <br /> �--G,U� SA� �M — <br /> M�KL-'S NE�N S16Ns <br /> �.�1� io�t�, 5r ST �vc�z�-r c ��S-� s�-�s <br /> CONTR.LICENSE p ���K�.S N S v33C� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � <br /> 1—\ ���- (/�fC^�� _Elodric _Gas_Olher `�a �ylj p� <br /> WORK OESCRIPTION <br /> ( NS-tA�� � WII�E C11ANu �. L lV'�JN L�TT � �C U f� <br /> I�Ac � wr�y ��c� c1-+��Nv�� �.�rr�its �� 'rt�on,T WA� <br /> —�LUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathlul> Forcad air systems <br /> Lavalory(wash basin) Gas piping <br /> Showor _ Watorheater <br /> Kitch�n sink 8 dispusal _ Gas�iroplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Watm hoaler Ranc�o hood <br /> Sink(servicol6arlmop/elcJ _ Exhaust fan <br /> Backllow provenlm _ Hoal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor Arain Refrigeration <br /> Grease trap _ Woodstove <br /> Rool drains , _ Other_ <br /> Other���-(,'v-_--_. — . <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS�105 <br /> II hereby ceritify Ihat i have read and oxamined Ihis applica�ion and know�he samo�o be true antl correcL All provisions ol laws and <br /> urdinaces goveming Qiis type ol work will be complied wilh whether specilied herein or not.The granling ol a permi�does nol presume <br /> lo yive au�hority to violale or cancel ihe provision of any o�her state or local law rogulating consWction or Ihe per(ormarce of <br /> consVuction. That I am authorired by tho owner ol this property to porlorm Ihe work tor which application is made and 1 wmply with Ihe <br /> Sla�e CoNractors Law 1E.27 RCW and 29Fi.200 WAC. (� <br /> L 9 �/L�C —� �� � p d' <br /> L �.--- <br /> SignaWibof nedConiraclorlAulhorizedAgenl Date �� <br /> (L <br />