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PtRMIT APPLICATIO�I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-6857—�vww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 _ � ��/(� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> /CoC� 7 aG�y Q� dv�,?��.��'�3�Jo � (o oa - 8 i? <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> oESc. -� �, �-�c'�r'L-""�'E�;�i �'j�v. L <br /> OWNER ADURESS CITYIZIP PH NE <br /> .g-ir•33Y•G°Yz� <br /> ,'�?�/G/f� � ���N�7'7�`IGNF�. /l007 C�"C.�3Y .�v� ' ' �g zn� _ <br /> TENANTNAME I CONTAGiFORPERMIT PHONE I <br /> E•MAIL <br /> ONTRACT ����� ADDRESS ITYI I H NE <br /> CONTR. LIGENSE t7 <br /> USE Of BUILDING � L/ HEAT SOURCE CONTRACT PRICE OF WORK <br /> �• �� �� '�1�E /X/[�clric _Gas_Other � g���� <br /> WORK DESCRIPTION <br /> ��UHD ErCrhT ��A'�Ca�, ��f'�'� tvrry N�w �a�(f�AC� ��-� ��'�C/ <br /> �,1��, ,� ; n2 3 <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Tuilel _ !VC–air handlin�unils <br /> 6athtub _ Forced air syslems <br /> Lava!ory�wash basin) _ Gas piping <br /> Showcr _ Water heater <br /> I(ilchen sink&disposal _ Gas liieplace <br /> Dishtivasher Gas ranc�e �� <br /> Clolhes washer _ Clothes dryer <br /> Waler heater _ Range hood <br /> Sink(service/barhnop/etc.) __ [xhaust(an <br /> Dackllow preventer _ tieal pump <br /> Urinal _ Unit heater <br /> Orinking Founlain _ Boiler <br /> Floordrain _ Refrigeration <br /> Greaso Irap _ VVwdslovo <br /> Roof drains _ Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y Ihal I have read and examined this application and know tho same lo bo Irue and correcl. All provisions ot laws and <br /> ordinac^s goveming this typo o(work will Ue complied with whelher specified herein or noL The granting of a pertnil does not presume <br /> to give authority to violato or cancel tho provision of any olher slate or local law regulati�y construction or Ihe peAormaoce of <br /> conslruclion.Thal I am auihorized by the owner of Ihis property lo pariorm lhe work for which applicalion is made and I comply wilh the <br /> Slalo Contradors law 10.27 RCW 2nd 29G.200 WAC. <br /> , . . - , . ., .�; <br /> '�"`��� '�' � �`%'�li�:'�=t� ��K `;��''/C7 <br /> Signature o(—OwneuCo�raclorlAuthonzed Agenl Date �' <br /> Z <br />