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� '.. <br /> PERMIT APPLICATION � �t�"�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810- FAX 425-257-8857-www.everettwa.org �-1 S=(� <br /> APPLlCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �,U�U 3 ' ���' <br /> SITE ADDRESS �j�q' CLI�('�l� {�V(� � PARCEL TAX I.D.N ERMR t <br /> Wf� �'�' ���-�4?� (c��Ec.�l`la; - ��— <br /> LEGA LOTNO. BLOCK TRACT -}— <br /> DESC. � . ) ���`'��� �� l <br /> OWNER ADDRESS � CITY2IP PHONE <br /> r��� (.�,����G M��.,,cN ����9 e�����;r ti��• �tit't�1��T qzc, ��u�2��`ii <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ;�` �(� ��� � �1���� �t�t�t1� � q�-3+`l- A�?-�- <br /> CONTRACTOR ADDRESS CITY2IP / � PMONE 3�y � I L1 <br /> CONTR.UCENSE� <br /> fi`�j �a�-,� U IU� '�--� f <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �V�l���-�'1�� /���� �Eledric �Gas_Other � Id � � � w <br /> WORK DESCRIP710N �"G^�1 <br /> �t,�n:l-�-rc: bx���-�r�c� �-tri�.�-r ��:�r� ��=�c;'�-� I��'� Cc�`� . <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> BatnWb 1 Forced eir systems �0� C F M <br /> � Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplece <br /> Dishwasher Gas ranpe <br /> _ Clothes washer Clolhes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(servicePoadmop/elc.) = Exhausl tan S v � Fyy� <br /> Backflow preventer Heat pump <br /> � Urinal Unil healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Rooi drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TIU(CODE�S 1105 <br /> I hereby ceritify lhal I have read and examined Ihis application and know the same�o be true and corred. AI�provisions o1 laws end <br /> ordinaces goveming this type of work will be wmplied with whether specified herein or not. The granting ol a pertnit dces not presume <br /> to give authorily lo violale or cancel the provision o(any other state or bcal law regulating construction or lhe peAormance ot <br /> construdion.That I am �ulhorized by the owner of lhis property to perform lhe work for which application is made and I comply with lhe <br /> Slale CoMradws Law 18.27 RCW and 296200 VJAC. <br /> . � ' 0 � :�3-�a� <br /> Signature ol OwneriConlractor/Auth�nzetl Agenl Date �' , <br />