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-�' ;,- <br /> PERMiT APPLIC,ATION <br /> GITY 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 8 AM TO 4 PM <br /> SITE ADDRESS pARCEL TAX I.D.# PERMR# <br /> .S �'/ '- O�Cv <br /> LEGA LOT NO. BLOCK HACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ro�D.� f�oc.�ll�� v-,�� ��.ZS�i'.m����v �,��/o C��[��-- <br /> TENANTNAME CONTACTFOHPERMIf PHONE <br /> ���e����G'� I E-MAIL <br /> C6AfiRA0i�—' ODRE S CITY2IP P NE � <br /> �.�/�Ji��vrih-�d ,�S,�oL , ��ZS-Z����'s� lr7S-77S`—/y7f� <br /> CONTR.LICENSE p _/ � j�.�� � ��� <br /> .�'//h�lp.y�2d�fla ��r/7� �T/l ���o <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �j7iJ��(�C.� I _Eleclric _Gas_Other I 3�("iv <br /> WORK DESCRIPTION <br /> /,�a�v�r�y✓c'�1� d .�/�����Z� / <br /> l-�e7` C/1/�✓:�✓r�/��i G��� ����'�� -c'P � <br /> PLUAABING MECHANICAL <br /> N0. TYPE OF FlXTUHE OR ITEM NO. TYPE OF F�XTURE OR ITEM <br /> Toiiet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas lireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preveNer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Rool drains O(her <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity that I have read and examined this apptication and know ihe same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whelher specilied herein or noL The granling of a permit does nol presume <br /> lo give authorily to violale or cancel fhe provision of any other state or local law regulating conslruction or the perlormanco ol <br /> constructio t I am aulhorized by the owner of ihis property to perform the work for which application is made and I compiy with ihe <br /> State C ra Law 18.27 RCW and 296.200 WAC. <br /> � <br /> Sign r wn Coniractor/Authorized Agent ale <br /> l� <br /> 2 <br />