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( <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 ADDRESS PARCEL TAX I.D.N P RMIT N <br /> �o t7 �,.� � d// - 00(o <br /> IEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDFESS CITYILP PHONE <br /> �Q�ev� � n I�(-1/iita(ez��0 'l �ti>�It✓i �'l �i/C.�'/f . �7 Y71�9S1. `/o8� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ���r�' s. CD � S �vuC�,o� � e-Maa�/?-�" ^�fi - �9�-3 <br /> -c.'aATRA �d✓�8�� CW M � <br /> �/�.b — �-�-� .�. �� ..��C e.�. Q �.,�� <br /> CGNTR.LICENSE K <br /> �6zl�s� � l <br /> USE OF BUILDING ( — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas_Other <br /> WORK DESCRIPTION <br /> �pL(.(,L CQ,1 G�a��i� � � Q� <br /> 1��� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR�TEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> _ Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwesher _ Ges range <br /> Clolhes washer _ Clothes dryer <br /> Water heuter Range hood <br />� Sink(service/bar/mop/etc.) _ Ezhaust fen <br /> BeckOow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodsbve <br /> Rool drains Olhet __ <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE 19 7106 I <br /> I hereby ceAify that I have read and exemined Ihis application and know Iho same to be true and correct. All provisions o1 lawa end <br /> ordinances governing this lype ot work�vill be complied with whether specifed herein or not.The granting ol a permil does not presume <br />� to grve authority!o vidate or cancel the provision ol any olher state or local Inw regulating construclion or Ihe pedortnance o( <br /> construclion. That I am authorized by ihe owner ot this property to perlorm lhe work for which applicalion fs made and I comply with the <br /> State Coniractors Law 1 2p RCW and 29�200 WAC. <br /> ) ( ,• �/ ` t�l�_ l�� /�d <br /> I J(P 1'�"� <br /> Signaturo ot Owner Contractor/Authorized Agent Dale <br />