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I 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 /> APPLICt1TIONS ARE ACCEPTED FROM 6 AM TO 4 PM � �,�� ��� <br /> � r <br /> SITE ADDRESS NC�—�'I�� l�%5� PARCEL TAX I.D.k ERMIT M <br /> ���3 w c�s�^%� ��� I I �- o i � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ��a E/n! G <br /> TENANT NAME ONTACT FOR PERMIT PHONE �,�y <br /> Z.DATRAL i �C I �� `�-'.Yr �b I�.SKI 41'� ��MAIL r✓� T �`J 9� <br /> l�oEi,�✓G <br /> CONTR.LICENSE M <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �1 r� Electric Gas Other �� �p� <br /> WORK DESCRIPTION <br /> /�sr�r�.i. � �Crc-(-E� �Z/�-c=K <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE 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 8 disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Clothes washer Clolhes dryer <br /> _ Water heater Range hood <br /> Sink(service/barlmop/etc.) Exheust fan <br /> _ BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigoration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETi LOCAL SALES TA%CODE IS J106 <br /> I hereby ceAify tl�af I have read and examined this application and know the same ta be true and correct. All provisions of lawa and <br /> ordinancas governing this type ot work will be complied with whether specified herein or r.ot.The granting ot e pertnit does nol presume <br /> to give authority lo vidate or cancel the provision ot any olher state or local law regulating cansiruclion or the peAormance of <br /> conslruction. That I am aulhorized by the owner of this property to peAarm the work lor wfiich epplication Is made end I wmply with the <br /> Stale Gontrectors Law 1 27 RCW an 296.200 WAC. <br /> _1.�,�n,� ���t�.���� Jl�/�� <br /> Si ature of Owne/ContraclodAuthonzed Agent Date (� <br /> ,2 <br />