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- - � <br /> P�RMIT 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 8 AM TO 4 PM i 2 `�5 � 6 <br /> SITE ADDRESS PARCEL TAX I.D.N I PERMIT N <br /> �,,� , ,, � � ,�5���� i��� �•� .�_ c-��,rz� �to�� a-oi� <br /> LEGA L07N0. BLOCK TRACT <br /> DESC. `:.`�\ . �f <br /> OWNER ADDRES8 CIiYIZIP PHONE <br /> ��� t1C71� �>>c�\_ � � , 5 1 '�:C� \ l� �C ►1<'_c'_( ���., .� `L � 4� �n�i �on w R <br /> TENANT NAME CONTACT FOR PERMIT PMO E <br /> I'-�N�� M�� ���.y �. k�'v , r� Coc �r.:_� �-G9�C' �J�l� � �/ <br /> CONTRACTOR � �-��, �—`, ` `l ADDRESS ` Z� Z 1 CITYIZIP PHONE <br /> ��c�Y���ri� Mu�l kct Lvc� 3 , 3 ��ti� <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � e 1_�` � ,�Eledric _Gas_Other $ ��� <br /> / <br /> WORK DESCRIPTION <br /> �� U �L <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM N0. TVPE OF FIXTURE OR ITEM <br /> Toilet � AIC—air handling unita <br /> Bathtub ,� Forced eir systems <br /> Lavatory(wash basm� Gas piping <br /> Shower Waler heater <br /> � Kilchen sink 8 disposal Gas flreplace <br /> Dishwasher Gas range <br /> C,lothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Smk (service/bar/mop/etc) E�hauSt fan <br /> I _ BackOow preventei __ Heat pump <br /> Urinal �, Unit heater <br /> I, Dnnking Fountain Boiler <br /> �I _ Floor drain Refrigeration <br /> I Grease Irap Woodstove <br /> i Roof drams Olher <br /> Other __ <br /> �, CITY OF EVERETT LOCAL SALES TA%CODE IS 7106 <br /> � I hereby centify Ihal I have read and exammed this appllcation and know the same to be true and corteq. All provisions of laws and <br /> .. ordinaces goveming thls type of work wlll be comphed wilh whether specified herein or not. The granting of a permit does nol presume <br /> to grve authority lo vlolate or cancel the provision of eny other stale or local law regulating construdion or the performance o( <br /> �� conslruclion That I am authonzed by the owner of thls property to peAorm the work tor which application is made and I comply with the <br /> I Stute f,on ractors Law 18 27 RCVJ and 296200 WAC <br /> i <br /> � ��'�� ---- �.1-�y��'�� <br /> � Sign ure a(OwnedContractorlAuthonzed Agent � Date <br /> l __ — <br /> �I L <br />