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7- -�7 - ��7 <br /> PERMIT APPLIC��TION <br /> CITY OF EVERETT PERMI'f SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everetwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM pG; ��jZ�;G S <br /> SITE ADDRESS �` PARCEL TAX I.D.# PERMIT N <br /> .2��� U C vC�l� " - � , � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OYVNER ADDRESS CITY2IP PHONE <br /> FV�1'ei� �hoc�l �DiSffi��" — <br /> TENANTNAME I CO�C� / Pp'� I IPI /v'�PNVv/ /O�� _- <br /> 11� <br /> C(JflTRACTOR AUDRESS CITYZP PHON <br /> , h1i�llei-{�YI�C�Gt�t-u'�a�P.��i� /7�„7y /5��/��r,�l�I/�/'�� �-k'06-08�10 <br /> �ur�_n.u�E�ISE R ,(/� � �)�U�Z <br /> l�l r��E ni�CGo p!i r � <br /> USE OF BUILDINCa — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Elednc Gas Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> H0. TYPE DF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> 8athtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> � Shower = Waterheater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> /g Clolhes washer _ Clothes dryer <br /> Laundry iray _ Range hood <br /> � Sink(servicelbadmop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigerafion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> dTY OF EVERETT LOCAL SALES TAX COOE IS�105 <br /> I hereby ceriliry that I have read and ezamined this application and know the same to be uve and co�rect. All provisions of�av+s and <br /> ordinaces goveming this type otvrork will be complied with whether specified herein or nol The granting ot a pennil does nol presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulaling consWction or the periormance of <br /> construaion.That 1 am authorized by the owner of this property lo peAortn the woAc tor which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> �l I D� <br /> Signawre of OwnedContradorlAuthonzeC Agent Dale <br />