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PFRMIT 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 /> APPI.ICATIONS ARE ACCEPTED FFtOM 8 AM TO 4 PM <br /> SITE ADDR)ESS' +'r �7 �/ �{,� /r{ � }�; �PfA�RCpEL TA�X7I.D.k �J���) PERId1T# //�.,/�y <br /> rv���,{� l../�V[r f i 1YtN�U Uv`T� 1�� L��I LW ���4��i.��, C-C�V <br /> LEGA LOTNO. BLOCK TRACT <br /> o�sc. 'f 12� 62g- �O[� <br /> OWNER ADDItESS CITYILf• PHONE <br /> (�1rK'c' �.INV� �'�2.r✓ �"M �cV�. �'i�l�"f� �5�00 �i�'�'(1..�, `�S��UI <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �1 ruT ���-��v����'�`.�� C�-�-s")z�2-ZlS� <br /> CONTRACTOR. ������� ADDRE55 CITY/LP PHONE <br /> �„ �� <br /> CON2R.LICENSE i <br /> I)SE OF DUILDlNG HEAT 50URCE CONTRACT PRICE OF WORK <br /> �j�1��f-}�;�j _E�earic �,Gas_Olher ��5� � 3 l� �v <br /> WORK DESCRIPTION <br /> ��ltL��"� �-t�x�� —tC=},tr�r�' (M�1zpV�M,�T `��� �I�-��- <br /> �u k- �� �'���'�-�T <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> dalhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas freplace <br /> Dishwasher Gas ranqe <br /> Clolhes washer Clothes Cryer <br /> Laundry tray R,n�e h•ood <br /> Sink(service/badmop/etc.) [xhaust ran <br /> Backliow pmvenler Heat pump <br /> Urinal Unit beater <br /> Drinking Fountain 8oiler <br /> F�oor drain Refngeration <br /> Grease lrap �Voodstove <br /> Roofdrains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerilify that I have mad and ezamined this applicaGon and know the same to be We and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether spcdfied herein or not.The granting af a pertnit does not presume <br /> to give authoriry to violale or cancel'lhe p�ovi�sion o(any olh=r slale or local�aw regulating conslruclion or the perfomiance of <br /> consWclion.That f am authorized by tfie owner of this propedy to pedorm the vrork for which ap^"ation is made and I comply with the <br /> State Contractors Law 18 R���d 29G 00,/W�AC. <br /> �; '�.�, �/" %��.,�.e.f �3•a3•o� <br /> SigpaM�e�ofOw�erlContractodAuthonzedAgent Date <br /> — — /,�7 <br />