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� <br /> PERMIT 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 /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM �j �- a �{'j(� <br /> SITE ADDRESS � PARCEL TAX I.D.N P RMIT 1l <br /> � ��L��'/�z'� � �1 �l��C-`f �% � l<'o�" � <br /> LEGA 10TN0. BLOCK TRACT <br /> DESC. <br /> OWNER AOORESS qTYILP PHONE <br /> �G�241�?�� �7/�(�,G�1�� '�03 �Gz%y S/�rc�,- � a ��`iD `�' 3Yi Y�- <br /> TENAN NAME CONTACiFORPERMIT PHONE <br /> v�C'-A"%c�0 /Flf'� I �X'lL- /V�ra�/ioux= �t'v�S7/��/</ <br /> CONTRACTOR ADDRESS GNlZJP PH NE <br /> f-�c�,°t�ic_ `.�c=r�U��=��, .:-,,c �, , ,� > <br /> coNrfe.uceHsex �/s/f!� /�?i/JG�t� �s,�" ��/D7 �K�`-u-9S7o <br /> /(.4'�'-l�/Si/Y."d'.�4 <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 5 i- [� ✓ElecVic _Gas_Other r�C�� <br /> WORK DESCRIPTION I <br /> r►�ze �r��n�a���. Rc�,v�rz �v i�oa�=. <br /> �'L=- (�i.z mF= , <br /> yt�•���:,_la�� . ?7f'�(Wrc.\\ "�cLIN�('. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toi�et A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas f�repiace <br /> Dishwasher Gasrenge <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/barlmop/etc.) Exhaust tan <br /> BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinl:ing Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> OUier <br /> CITY OF EVERETT LOCAI SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be lrue and correct. !JI provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether spedfiea herein or not. The granting o(a permit does nol presume <br /> to give auth ity to violate or cancel the provision of any other state or local law reguladng construction or the performance of <br /> construdi . That I am authoriz�by the o �er of this property to pertortn the work for which application is made and I comply with the <br /> (ate Con edor �LBv✓T8.27 R and 2 200 WAC, <br /> � - �a�� � � �� � � ti � �,ti��_l�' 5 �:: , . <br /> , <br /> Sgna ure of wner/Contrado Au onzed gen Dat <br />