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------— � -- - - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> I 425-257-8810- FAX 425-257-6857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 6 —�5 �I D <br /> SITE ADDRESS � "� PARCEL TAX I.D.# PERMIT fi <br /> -�,o ,� ���, C�S�N�� �zr _ -v�_ <br /> LEGAL LOT NO. BIOCK TRACT OR SUBDIVISIOY N <br /> DESC. <br /> OWNER ADDRESS GITY2IP PMONE <br /> � iNC�' I <br /> iENANT NAME NTACT FOR PERMIT PHONF��2J- �7�. ��_�9 <br /> ���5 ��� �i ���71._�.��� (�if:� �� E�MAIL� <br /> -Z '�A6bF1��'-- I <br /> (-]n 1�..JI/ /�� �. i- � NG' <br /> i CONTR.IfCENSE N <br /> I USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �,�+' I- � (,LS � _Eloctdc _Gas__Olher 'J(�� p!'>C� <br /> WORK DESCRIPTION � �}?(} � (�(7, � <br /> � ( .i (' �t i� /�/l I�C F � C�1- I'1C � <br /> /,F <br /> -- PLUMBING MECHANICAL <br /> Np, TYPE OF FI%1URE OR ITEM NO. TYP[OF FIXTURE OR ITEM <br /> Toilel _ NC -air handling units <br /> Balhtub __ Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Walr.rhealer <br /> � _ Kitr.hen sink 8 disposal ___ Gas lireplaco <br /> Dishwasher ____ Gas ranc�e <br /> Golhes washor _ Clothes dryor <br /> Weter hea�er _ _ Range hoo�1 <br /> � Sink(sorvicelbarlmople�r..) _ Exhaust fan <br /> i .— Heal pump <br /> __ Back(low prevoNer Unit heater <br /> Urinal — <br /> Drinkin�Fountaii� _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woods�ove <br /> Roof drains __ Other <br /> G�her _-_ -- _ <br /> iCITY OF EVERETT LO�AL SALES TAIf CODE IS 7105 <br /> �II heroby cerilify lhat I have read and examined this app�ication and know Ihe same lo be irue and correct. Ail provisions of laws and <br /> ordinaces yovominy Ihis lypo o(work will be con-�plied with whether specilied herein or noL The granling of a permit does not presume <br /> ito qive aulhorily to violate or cancel�he provision of any uther slate or local law regulating cunsWdion or Iho poAormance ot <br /> conslruclinn.That I am aulhorized by lheqwner of Ihis property lo perform the work br which application is made and I comply wilh ihe <br /> StatAConimctors Lj�w 1 7 CW ��96.200 WAC. <br /> " n <br /> � /o;e-r��- � /� ,,., .�� � �� <br /> �� ' iynaWro ol OwnedConlrar,lovAuthorized Agenl Dale � <br /> �I � -- -- � -___ __. ._. . ___.. - - ----- ---- ----- ��-------- <br />