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P <br /> ERMIT A <br /> PP�_ICATION <br /> CITY O� EVERETT PERMIT SER�lICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425•257-8857-www.everethNa.org <br /> APPLICATIONS AkE ACCEP7ED FROM 9 AM TO 4 PM f�-- $—Ug <br /> SITE AUURES�� �� f'ARCEL TAX�.D N PERMIT A <br /> � ��,. C�s „�� ,�, I Y3� - �3� <br /> LEG�. L01 N0. BLOCK TRACT OR SUBDIVISION N <br /> DCSC. _ . CITY2IP PNO E <br /> � OWNER ADURESB <br /> �O���G� <br /> TENANTNAME Cf�NTACTFORPERMIT PHONE <br /> goE /�G I �' 71 C��'�130�-5�� e�na� <br /> z�oaraa�arr— <br /> T�7 <br /> CONTR.LICENSE N <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> i/�T� �p,/ _,Electdc _Gas_Olher �� pGOJQ�U <br /> K <br /> WORK DESCRIPTION <br /> U P Dl+tE f�-� �,�c ac��-SE l�A.� ��G f I�E�P-. <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Tollet _ AIC—alr handling unils <br /> Balhtub _ Forced eir syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Showor _ Walerheater <br /> Kitchon sink 6 disposal _ Gas Iireplace <br /> Dishwashar __ Gas range <br /> Clolhes washer _ Clothes dryer <br /> Water hnatar _ Range hood <br /> Sink(service/bar/mop/otc.) _ Exhausl fan <br /> Backllow provenler _ Heal pump <br /> Udnal _ UNt healer <br /> Drinking Fountain _ Boiler <br /> Flaor drain _ Refrigerelion <br /> Groase Irap _ Woudstove <br /> Roo1 drains _ Other _ <br /> Other — "— <br /> CITY OF EVERETT LOCILL SALES TAX CODE IS 7105 <br /> I hereby cerili(y Ihal I have road and examined Ihls appiicalior and know the same lo be lrue end corcect. All provlslons of laws and <br /> ordinaces governing Ihis lype oi work will bc compliod with wholher specified Iierein or nol.The granling ot e perm�l doe�nol presume <br /> to give authority lo violale or cancel the provision ol any olher slate or local law regulaling conslrucUon or lhe perfortnance of <br /> construclion.That I am aulhorized by lhe ownor of lhis pmperty lo perform 1he work lor which epplicalion Is made and I comply wllh the <br /> Sta� Conlraclors Law 18.27 RC and 296.2 W . <br /> � ���,�� 9 ��� �� - <br /> ignature o1�OwnedConlraclon:�.ulhorizod Aganl �a�O �IZ <br />