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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREFT, EVERETT, WA�8701 <br /> 425-257-E810— FAX 425-257-8857 —www.eve��tiwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM '� �.3 �p J <br /> SITE ADDRESS PARCEL TAX I.D.!1 RMIT� <br /> 1 7.27 caL. r3 � poy3 � �v3 - Y �� -iyoo 7r�/v - 73 <br /> LEGA LOT N . BLOCK TRACT OR S/UBDIVISION# � / _ <br /> DESC. 3t� ' J C /7�'!/ L P�tT <br /> OWNER ADORESS CITY2IP PHONE <br /> To w y u t1— i �� � � o[ i3 y �� e,� f� Y,� 5 2 5 ,? v9T3 <br /> TENANTNAME 1 CONTACTFORPERMIT<r PHONE �� 5 3�q �9.� 9 <br /> r–'(j Ll.'�'�. � 0.1 !�D!t �.Qsf S�/� C.- O� I � � i'✓1 T� S P E-MAIL <br /> p DD E I /ZI N <br /> CONTR.LICENSE p /CU��IJ���G O S'��[ �y` � �`/~ r r �U C✓'f �/ l�.1 S- 3/9/-9.? 9 <br /> 9�',� o I <br /> USE OF BUILDING I — ItEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclnc Gas_Other � ,���Q Cr G 0 <br /> � <br /> WORK DESCRIPTION ` <br /> �=c+�,...t d a�� �`6 n;` Y- e. /r� c� i` .- �.�..n 6 e.� L- J�!-S'�r`n� `-/o c�. ,�� <br /> (' <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C–air handling unils <br /> Balhtub _ Forced air systems <br /> Lavator�(�Nash basin) _ Gas piping <br /> Shower _ Water healer <br /> Ki�chen sink 6 disposal _ Gas fireplace <br /> Dishwasher __ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink(service�/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump i <br /> Urinal _ Unit healer I <br /> _ Drinking Fountain _ Boiler <br /> Floor drein Refrigerafion <br /> Greasetrap _ Woodsrovo <br /> i Roof drai�s Olher <br /> I _ Other — <br /> C�TY OF EVERETT LOCAL SALES 1'AX CODE IS 7105 <br /> I hereby ceritify that I have read and oxamined lhis application and know the same lo bo lrue and correct. All provisions of laws and <br /> ordinaces go��erning this type of work will be complied wilh whether specitied herein or noL The grenting of a permit does nol prasume <br /> lo give authority to violate or cancel lhe provision of any other stale or local law regulaGng consWclion or the performance of <br /> cnnstruclion.That I am aulhonzed by ihe owner of lhis property to perform lhe work tor which applicalion is made and I wmply wilh Ihe <br /> State CoNractors Law 18.27 CW and 2y6.20U WAC. <br /> � �� <� .� �/,� �'�'.,r� � � � � � � <br /> 'i Sign re ot OwnedCU^� ctodAutt� nzed AgeN Date <br /> `�Z <br /> � , � <br /> i- _ — - -- -- -- — __� <br />� - <br />