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-- - r <br /> r 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 8 AM TO 4 PM � �,S „FJ� <br /> �E ADDR�S _ � � O�Q 3CEL TAX I.D.�b Q P MIT� _��� <br /> 7 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS CITY2IP PHONE y�� <br /> na�+nro4 Ro6 LL � M Re�e. S63/ fvu�rcert wac t►'r�c�'l'�ida.c� S/3•�,ae/ <br /> TENANT NA E CONTACT FOR PERMIT PHONE <br /> �C.Gi f,'G PR,wlr` ll;,�.1 �{unT �lZ.5�. 77L^88 <br /> CONTRACTOR OU,� N�Q S'��K s'Ysf�SDDRESS CITY2IP PHONE �2�", <br /> l7 �/ e, /� <br /> CONTR.UCE�E# �G� T�� i►4��CSOA /G[ "'��� '7`'�D� <br /> err I�CQ y8.to3 0 <br /> USE OF BUIL�ING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Q e.�i I rv�Electric �as_Olher 6���8� <br /> I� — <br /> WORKDESCRIPTION f,H$�R/ Gi✓ (�,�jf�f Q� EXi$�iAQ S SV� �� <br /> v <br /> ( PLUMBWG MECHANICAL <br /> NO. 1 TYPE OF FIXTURE OR ITEM NO, � TYPE OF FIXTURE OR ITEM <br /> Toilcl A/C—air handling unils <br /> Balhlub Forced air systems <br /> Lavatory pvash basin) _ Gas piping <br /> Shower W aler healer <br /> Kilchen sink&disposal Gas fireplace <br /> Disinvasher Gas range <br /> Clothes washor Clolhes dryer <br /> Waler healer Range hood <br /> Sink(sorvice/bar/mop/elc.) Exhausl fan <br /> Back(Iow prevenler _ Heal pump <br /> Urinal , Unit heater <br /> Drinking Founlain __ Boiler <br /> Floordrain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihal I have rcad and examined lhis application and know lhe same lo be true and correcl All provisions of laws and <br /> ordinaces c�overning this lype of work will be complied with whelher specified herein or not.The granling of a permil does not presume <br /> to give authority to vioiate or cancel the provision of any olher stale or local law regulating consWction or the performance of <br /> construction:Th I am aulhorized by lhe owner of lhis propedy to per(orm lhe viork(or which application is made and I comply wilh lhe <br /> Slafe oM�acto aw 1£I 27 RCW and 296.200 WAC. I <br /> `, . <br /> / � � <br /> S na re of wne on ra or/Authorized Ac�ent Dal /Z <br />