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PtRMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES / 2 -��(--�-� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org /�'�07/�p3 <br /> APPLICATIONS ARE ACCEPT�D FROM 8 AM TO 4 PM <br /> SITE ADDRES � PARCEL TAX I.D.# PERMIT�I <br /> �(,�'/�� L�c%�,ti. �f t'c-': ��yr�f� � � <br /> LE-GAL l0T NO. BLOCK TRACT OR SUBOIVISION H <br /> DESC. <br /> OWNER ADDRE55 � CITYIZIP PNONE <br /> ,� /�I�' ��r�,c°.� ��� ��/�� �l�l��'I�'� t r��'kPlt,u-A ,�5_�;�'r��° r'r <br /> TENANT NAME I CONTACT FOR PE lSIIT PHO��(.�1�� �� "£OT� <br /> f�2r/� C ' �hcpur;nC� C wr. n <br /> E-MAIL <br /> O TRAC R D S�ST— TYIZI G�JC <br /> 1«,�, ,rr ��� �'�.Y 1��,��`� �C<< <�i/�f� /,�'3>aF-� �' � <br /> J�rr ,� <br /> CONTR.LICENSE N r� �7 �q ��j;;��7�� <br /> j�l-��'l ll 1 f�� /l� ����"7�'7� �✓.� �c-- /_ <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric '` Gas Olher -,���-% �� <br /> i ��,t�'. � . <br /> WORK DESCRIPTION <br /> _��� �/;�� C° <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXIURE OR IiEM NO. TYPE OF FIKTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> _ Balhlub Forced air systems <br /> Lavalory(wash basin) � Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water heater Rango hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> 6ackflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ 8oiler <br /> Floor drain Refrigeretion <br /> Grease Irap Woodstove <br /> Roof drains � Olher (�� �-�ZAiCr�- �nr,�t ,hw.(�-y��rJ <br /> Other <br /> LITY OF EVERETT LOCAL SALES TA7(CODE IS 3705 <br /> I hereby ceritity that I h; .. read and examined this application and know lhe same to be lrue and r,orrect. All provisions of laws and <br /> ordinaces governing�:�:<type f work will be complied with whother specilied herein or not.The grenting of a permit does not presun:= <br /> to give aulhority to violat�or ancel ihe provision ol any other slato or lor,21 law regulating conslruction or the performance of <br /> construction.l�hat I �aut rized by tho owner of lhis property lo pertorm the work for which applicalion is made and I comply with the <br /> Stale Contractors ] .�7 RCW and 296200 WAC. � � <br /> ' %4` iC' ,� (, <br /> SignaWre , Owrj NCotftraclor/Authonzed Agenl � D te �/,� <br /> � � <br />