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—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 /> APPL ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM CJ �Gr �-Q � <br /> SITE ADDRESS Sr�w µ'►' PARCEL TAX I.D.ll P RMIT p <br /> w �,,�a .�-� .!� n -.�o <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC, <br /> UWNER ADDRESS CITY/ZIP PHONE <br /> ���NG <br /> TENANT NAME CONTACT FOR PFRMIT ��PH�G ���–p7 <br /> (�� I T�/�+B,ai4S'K/ ✓ <br /> I,X/��N�' E•MAIL <br /> I <br /> G��,4.,cy ►H�L�Nv Go�+sT. <br /> CONTR.L16ENSE k <br /> USE OF BUILDING(�f/�j�''� HEAT SOURCE CONTRACT PRICE OF WORK <br /> �D��� —Elcr.lric ___Gas_Olher �O�OOG <br /> WORK DESCRIPTION <br /> ���"P�p OdS wt /�-r62yGi.5 S�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel _ NC –air handling unlls <br /> �alhlub _ Forced air syslems <br />� Lavalory (wash basin) __ Gas piping <br /> Slwwer _ Waler heater <br /> Kilchen sink 8 disposal __ Gas liieplace <br /> Dishwasher _ Gas range <br /> Clothes washer __ Clolhos dryer <br /> Walur heater _ Ranga hood <br /> Sink�sorvicclbarlmopielc.� __ Exhausl(an <br /> BackOow prevenler __ Heat pump <br /> Urinal __ Unil heater <br /> Drinking Founlain ___ Doiler <br /> Floordrain _ Refrigeratiun <br /> � � Greaso lrap ._ Woodstove <br /> Rool drains _ Other <br /> Other--_------ — — <br /> CITV OF EVERETT LOCAL SALES TAIf CODE IS 3705 <br /> II hereby contily that I have reaA and axamined this application and know tho samo lo be lrue antl correct. All provisions ol laws and <br /> ordineces c�ovoming this type o(work wdl be complied with whnlher specifieA herein or nol. The granling of a permil does nol presume <br /> to yive authorily lo violalr,or cancel Ihe provision ol any olher sta�e or local I�w regulatinq construclion or tho periormance ol <br /> consUur,tiun. That I am�uthorited by Ihe owner ol�his property lo pertorm Ihe worA lor which applir,ation is made and I comply wilh ihr� <br /> Slale onirar,lors Law RCW a A 29fi200 WAC. / <br /> G�� G���/-�'' v o� � <br /> Signature ol Ownor'ConlractnrlAuthorized Agenl Da�e �� <br />�, � . .. ._ . .. -- ---- ---- – . _.----._. <br />