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P��2MIT APPLICATIOON ,.J� <br /> CITY OF EVERETT FcRMIT 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 ADDRE53 � PARCEL?AX I.D.N P IT A <br /> �Yei'LG�tI Gtlr9 0� '� <br /> LEG/I LOTNO. BLOCK TRACT <br /> DESi:. ' — <br /> OWNER ADDRESS CRY21P HONE <br /> � ���an1A�A 26 - IO6 �3 �cia22fs�� G�� �►i�� . <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �� ��.s���/ � ���� ���a���_ y�s-�sy 3� � <br /> CONTRACTOR�2�j�C7 �VlCx� DRE33 ��l,IO-�y7���-�, /✓C P'�NQ-�f}& <br /> �l�O�Ql�/_ � <br /> CONTR.LICENSE M �,4/�CE Si�i�CS (.cJA • ��'$ <br /> /��T�� CCl�/�/�C _ <br /> USE OF BUIIDING HEAT SOURCE CpNTRACT PRICE OF WORK <br /> �,z�� 1�� � � <br /> � — / _Electric�Gas_Other �� /�, oG1D <br /> WORK DESCRIPTION <br /> /�7..a'.4-Ti� : '!.�/� S/-�i� ,�crr -/o�O/- T� `I�'7�/- t�.C7t�c�/ � , <br /> ' � " ' r s .�� <br /> ��y <br /> �e � •l� pLU BING �C - M CN NICAL <br /> µU. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITE6� <br /> Toilet �� Fo ced air snstems nils --^ • ' <br /> Balhlub Y <br /> � Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> � Dishwasher as range <br /> _ Clothes washer _ C thes dryer <br /> L�aundry tray Ran e hood <br /> � Sink(service/bar/mop/etc.) _ Exha tfan <br /> Backflow preventer Heatpu p <br /> Urinal Unit heate <br /> _ Drinking Fau�ain Bofler <br /> Floordrain � Refigeration <br /> � Grease trap -� W�S� _ Woodslove <br /> _ Roof drains _ Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming thfs type ot work will be complied with whether specified herein or not The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the pertortnance of <br /> construction.T I am authori ed by he owner of this property to perform the work for�.vhfch applicadon is made and I comply with the <br /> State Contrac s Law 1827 W d 296200 WAC. <br /> Q <br /> Sigri3ture of n n ra dAut Agent Date �/ <br /> /�. <br />