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-; - - <br /> � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES S - a-� � <br /> 3200 CEDAR STREET, EVERETT,WA 98201 S O �O S -1 �Z <br /> 4?_5-257-8d10- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROPJI 8 AM TO 4 Ph1 <br /> SITE ADDRESS � r,�Q?RS'jEJ,TAX_�•U i�,� ��MIT# <br /> 10 ► a� - �v��,����r��%rL �y �����JCL -�os-c;o� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> a �Or� �'��n AD�RESS CITY2IP PHONE <br /> OWNER � � D• ,�p� <br /> �� � �^_� – �"`P �} V-'G N= �a���Vvi;� 6••'/j� <br /> f•���1�f1�' /�sS�T .1 t��7sr�7zS� ' ,,c�:,.�, <br /> TENANT NAME � CONTACT FOR PERMIT 1PHONE <br /> ��IVIC '�Stb,�.� hZj�1K �tiiJ2��ts (�(2_�1 53c,•�/lno <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> ('7��r r �l(v� :tli'✓f Ci:S I�ZI2 ts'�I?I&.l Cl'c'�r"'Yr �hr=� �Llll.� C��� �tZS <br /> CONTR.LICENSE# SW7E (-' 23`) ��/.} 3 3 c� �/(,v <br /> I�t:I�S(S�'�` �!1 J P� <br /> US[OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> tl � <br /> _Electric _Gas__Olher �5,,;� <br /> WORI(DESCRIPTION <br /> ZIJSI`1ZL. e:;.f� �.l-��'�-�v". 1���1=�C (71�i`�C.'\-� <br /> PLU�"31NG MECHANICAL <br /> N0. TYPE OF FI: i RE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Sliower W ater heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/m�p/elc.) Exhaust fan <br /> Backflow prevenler Healpump <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> Floor drain � Refrigeration <br /> Grease Irap Woodstove <br /> Roof drains �� Other S � F,J <br /> Other <br /> CITY OF E\'ERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerilify lhal I hav�; read and examined lhis applicalion and know lhe same to ba true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whet!ier specitied herein or not.The granting of a permit does not presume <br /> to give authority to vioiate or cancel the provision of any ulher state or local law regulaling construction or the perFormance of <br /> conslruclion.That I am aulhonzed by lho owner of this propeAy lo perform the work for which application is made and I comply wilh lhe <br /> Stale Contraclors L �8.27 RCW and 7_96.200 WAC. <br /> � � �f��� <br /> SignaWre of Own ntraclodAulhorized Agent tDa e— �� <br /> i <br />