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� t <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, FVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 'l �. �� —Q� <br /> SITE AUDRES PARCEL TA% I.D.# PeRM}�# <br /> �I.1� �UP✓G ft,�:�� �� � �� ( C/ODOQ f5�/�� /� DO7 -� <br /> LEGA LOT NO. BL7CK TFiACT OR SUBDIVISION tt <br /> oES�. � �i a��n-�, <br /> OWNER AUDRcSa CITY/ZIP PHONE <br /> TENANT NAME CON7TACT FOR PERMIT PHONE� fj '��y L <br /> / 1 —�'liM LI .'LeC7�Ct✓i�GWI/1 'K.(rT �� � "— E-MAII /��1�,���2iG�SG�iC /��i� <br /> CONTRACTOR ADDRE S CITYI IP PHONE <br /> C-;Ye�a`�7�,.^. Co✓P 5'��S- Gc,.�.w(c,- � .��r� r�3�� �x•-3�-�-k��.�� <br /> CONTR.LICENSE p /�T���� �� ' /�� �� <br /> �. % ✓ <br /> USE OF BUILDING I — HEAT SOURCE �CONTRACT PRICE OF WORK <br /> ����f�,�� Electric �as Other 13 o�P <br /> W�1�o✓Z-T��t/D �� /G l/ �/�Zt 2 �-(✓�2�i.� r7J�C�� ��j�!"'�'�` �(J� Tcl,� <br /> �lti��,� � � � � ��� � vr� �1� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ tiC-air handling uni�s <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) __ Gas piping <br /> Shcwer _ Water heater <br /> Kitchen sink& disposal _ Gas (ireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer � Range hood <br /> Sink(service/bar/mop�etc.) � E�haust fan <br /> Elackllow prevenler _ Hrrat pump <br /> Urinal Unit healer <br /> Orinking Founlain _ Boiler <br /> Ploordrain _ Refrigeration <br /> _ (,rease trap _ Woodstove , <br /> Roof drains �_ Other�tt� V�� U�t 1 r <br /> Other _ --- — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify�hat I have iead and examined Ihis applicalion and know Ihe same to be irue and correct. All provisions of laws and <br /> ordinaces governing Ihis type ot work will be complied with whelher soecified herein or noL The granting of a permit does not presume <br /> lo give authoriry to violate or cancel Ihe provision of any other state or local law regulating construction or the perlormance of <br /> consiruction. Thal�I mauthorized by Ihe owner ol this property to per(orm the work for which applicalion is made and I comply with the <br /> Slale Conlr �Law 1827 and 296.200 WAC. <br /> �<�%�'^' 7��v/�� <br /> Sighateiro-0f OwnedContractor/Auihorized Agent � DatT �/ <br /> (� <br /> � -- <br />