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PcRMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—ww�•r.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �AR/l��/I��n 7 C PERMIT# — <br /> �- !ti (�.� � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��a 4''�^^ �rM.� �c � L,,� <br /> TENANT NAME CONiACT FOR PERMIT PHQNE �r_27�_0 0 9 2 <br /> � ,ij/�/�/—GI ���Nn �� i '��'f� IT�I/r E-MAIL �.W�*eS��+�� Ow <br /> COA RA T � <br /> 5.�� �� /9��6 N�y 44-�A- �r�,���( ��36 t�zr-27T-° 9z <br /> CONTR.LICENSE# <br /> �r����Trn <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric _Gas_Other � �.�,o <br /> WORK DESCRIPTiON <br /> �,S'-��.� .z I,✓G If C�,����5 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handlinc� unils <br /> Bathtub Y Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal ` Gas tireplace <br /> Dishwasher Gas range <br /> _ Clothes washer .V _ Clolhes dryer <br /> Waler healer � � \' Range hood <br /> Sink(service/badmop/etc.) ! ��'tl' _ Exhaust fan <br /> BackOow prevenler �' ^ _ Heat pump <br /> Urinal `.J _ Unil healer <br /> _ Drinking Fountain �- " Boiler <br /> Floor drain ^� Refrigeration <br /> _ Grease Uap n I � Woodsrove <br /> _ RooF drains `i ` _ Other <br /> _ Olher ` _ <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 3105 <br /> I hereby ceritify lhal I have read and examined this application and know lhe same lo be lrue and correct. All provisions of laws and <br /> ordinaces governing lhis lype of work will be complied wilh whelher specified herein or not.The granling of a permit does not presume <br /> lo c�ive authorty lo violale or cancel lhe provision of any other state or local law regulaiing conslruction or the performance of <br /> conslruction.Thal I am aulhorized by the owner of Ihis property lo pedorm ihe work(or which applicalion is made and I comply wilh lhe <br /> Stale CoNraclors Law 18.27 R Y11an�296.200 WAC. <br /> �-�-- �� �/3-A � <br /> SignaWre o(OwnedConiractodAulhorized Agent Dale � <br /> Z <br />