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f <br /> PERMI'i' AF'PLICATION <br /> CITY OF EVERETT PERtiIIIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everett�•�a.urg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS PARCELTAXI.D.# PERMIT#6_ � <br /> f'�'� <br /> �r�� > �'�1- ,�.�-r C�� c; �7� i 01 <br /> LEGAI LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �,� - J�c�ZE' <br /> G���r ��- �' /�/�9-73 �''� ��l F >��,,,/ ��,� yz�- 7� 7- Z�y - <br /> TENANT NAME CONTACT FOR PERMIT PHOIJE <br /> G�� r„y- ��/ /C��= / �G ,� �fz�-z 3�/ 7z � <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �.r��,qrr��'.,. s�/z: �Y 5�,.,,, ��,� c ,�L �c-rii��5` !' Z,-�- 2l� / <br /> CONTR.LICEN,JSE/#�/ / ����� �"�"�J��r�'���� /Sz J I 7 z � <br /> .� T L-/7�G�5%C���Z A�Z <br /> USE OF BUILDING �1\�'l� � HEAT SOURCE CONTRACT PRICE OF WORK <br /> / ij;��p� �� ,��,ti r , _Eiectric �Gas_Other 7���r— <br /> L V <br /> WORK DESCRIPTION <br /> � / <br /> / . (�- / /��� � C���� �--�r � � �'� <br /> t�' /�L �� �e � <br /> I <br /> PLUMBING !�IECHANICAL � <br /> N0. Tl'PE OF FIXTURE OR I7EM NO. TYI'E OF FIXTURE OR ITEM <br /> Toilel ' • ,A/C-�air handling unils , , <br /> Bathlub Forced air syslems <br /> Lavalory(wasti basin) �_ Gas piping <br /> � Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhe�dryer <br /> Waler healer Ran9e hood <br /> Sink(service/bar/mop/etc.) _i Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unit healer <br /> Orinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Olher <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y lhat I have read and examined lhis applicalion and know the same lo be true and correcL All provisions of laws and <br /> ordinaces governinc�this lype o(work will be complied wilh whelher specified herein or not."i he granling of a permil does not presume <br /> to give authoriry lo violate or cancel lhe provision of any other state or local law regulating consWction or the performance of <br /> consiruclion.That I am aulhorized by the owner of lhis property to perform the work for wliich application is made and I comply with the <br /> Slale ConUa�rs Law 18.27 RCW and 296.200 WAC. <br /> �"' ' i;'��� <br /> < �/ �, -'� �-Z --r� 7 <br /> SignaWre o(OwnedC nt actor/Aulhorized Agent Date �/Z <br />