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t i <br /> 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 8 AM TO 4 PM "\ . <br /> SITE ADDRE33 PARCEL TAX I.D:N I D� 7 G <br /> I I 1 O c.�-4�.��T�UT �v� oor{ 3 £�3 ZZ E3�1 �o�� �-p� <br /> LEOA LOT NO. BLOCK TRACT lM SUBpV1310N 1 <br /> DESC. (�] � I`3 L2�i Do0 E�! %Q.Cl� rJ�V o N�-�r <br /> A � Zv� -- <br /> �AtI�IJ ��rlc,� �orv;,1- l'�11 �hl 5�:��' Sj SEA11l-�, ��fiiD3 S9;�oI4 <br /> 7ENANTNAME I CONTACTFORPERMIT PHONE.}2C- 2S2 -12 �•• <br /> �mpes_.�o..c�c.•.,�J,i <br /> ImP2E:iSioN [��iyN e�N�hotr,�,l •c.cM <br /> �-AM �xcAvM�r�r�, ISoS�+ �� NS11o,cru.-�. <br /> coNrn.ucense• q 8 155� <br /> USE OF BUILDIN(i HEAT SOURCE CONTiiACT PRICE OF WORK <br /> ��� SI�-W�- FA�„�Y ��a`'�''`F`' I Electric _Gas_O�her <br /> ��� /��-t�F� — <br /> WORKDESCRIPTION T�EMu� irlu�� rF 5i„14LG F/�����.`( kFS�OrN� <br /> PLUMBING MECHANICAL <br /> Np, 7YPE OF FlXTURE OR fTEM NO. TYPE OF FlXTURF pp 17EM <br /> Toilet _ A/C—air handling unils <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) _ Oas pipinp <br /> Shower Water heater <br /> Kilchen sink 8 dispasal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryor <br /> Water heater Range hood <br /> Sink(servicelbadmopletc.) Exhaust lan <br /> Backllow prevonter Heat pump <br /> Urinal Unit heater <br /> Drfnking Fountain Boller <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo1 drains Olhar <br /> Other <br /> GTY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify thal l have read and ezamined thfs application and know the same ro be true and correct All provisions ot laws and <br /> ordinaces govemirq this type ol work will be complied with whelher spedfied herein or nol.The pranUng o1 a pertnfl does nol presume <br /> to give authority to vidate or cancel!he proviafon ol any other state or local law repulating consWclion or ihe per(ortnance ol <br /> construction.That 1 am authorized by Ihe owner ollhia properry la peAorm the work lor which application is made and I comply with the <br /> State Contractors Law 18.27 HCW and 296.200 WAC�. <br />� ���s�—� �� r� l��- ��. � � y� � <br /> Signature ol er ntracl Aut o zea�lpent aie <br />