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� <br /> � <br /> PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETl", WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM G --o��—��j <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT k <br /> � I� C L f l�� D60 - � ` <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �/{�1 G. �i�c,2cG�1 �81 y r dd y a�v <br /> TENANTNAM CONTACTFORP MIT PHONE <br /> l���C rH�P�R��v l�� 3� aog go�o <br /> CONTRACTOR � ADDRESS CITY2IP` PHONE <br /> 1 r�R i,� , 1? f�. � o J� �32osz P��.d� t�A. a53 <br /> I CONTR.LICENSE N /'l�� ) v� ���BR . ^ Ug`�O � <br /> / cr <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ` , �� c �� I _Eleciric �Gas_Olher <br /> WORK DESCRIP'fION /- <br /> �;,., Z i.,�. 'l�� ) /�r.iG GC'oRK� � nSd�. � . <br /> -� �i '�"j � u � �a-5 � <br /> �c.S �,IV�a 2 1'�¢ r� , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> l'oilel A/C—air handling units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) � Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwashcr Gasrange <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/elc.) Ezhaust fan <br /> Backflow preventer Heal pump <br /> Urinai Unit heator <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Greaselrap _ 1Voodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br /> 1 hereby ceriti(y thal I have read and examined this application aad know the same lo be lrue and wrrecL All provisions of laws and <br /> ordinaces c�oveming this type of work will bo complieA with whether specified herein or not.The granting of a permil does nol presume <br /> to give aulhorily to violate or cancel Ihe provision of any olher st2te or�ocal law rec�ulaling conslruclion or lhe pedormance ol <br /> conslruction.Thal I am aulhorized by the owner ot this properly to pe�form the work for which applicalion is made and I comply with the <br /> State Contreclors Ly�w 18.27 RCW and 296.200 WAC. <br /> � .:.sj` � O� .''1�-VLO . <br /> i <br /> S a ure D wnedContractor/Aulhonzed Agent Dato <br />