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� — ' <br /> PERMIT APPLlCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER :TT, WA 98201 <br /> 415-257-8810— FAX 425•257-8857—www.everettwa.org <br /> APPLICATIONS ARE AC(:'cPTED FROM B AM TO 4 PM <br /> SITE ADDR�E/SS � PAi'.CEL TAX I.D.# PERMIT# <br /> / l �`V� G-c� ( /' i, (i�/c . . � V1/� '�/ — <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �<�"_ >; :�, 5'S'33 io�� l�: � �1�,�fu�J/e s6o�GS9-2� <br /> TENANT NAME I CON'i ACT FOR PERMIT PHONE <br /> E•MAIL <br /> L;: `3 J o ,�J ��2 r C. -�M <br /> C�l / �'�G (GI,S� /�YtC ���� /a�6c'�6�Y�� �vt.�C�+ H.�'. /Alr'. 35� "-L�"' <br /> 7/�✓ <br /> CON�R.LICENSE� ���� <br /> USE OF BUILGING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> I WORK DESCRIPTION <br /> n��o C,�,y'� (C��s :Y�.,,,,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> _ Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sinl; (service/bar/mop/etc.) _ Exhaust fan <br /> Backflow prever.ter _ Heat pump <br /> Urinal Unit heater <br /> Drinking�ountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof dreins Olher <br /> Other <br /> CITY OF EVERETT LOCAL SAL[S TAX CODE IS 3705 <br /> I hereby certify that I have read and examined this application and know lhe same to be lrue and correct. Ali provisions of laws and <br /> ordinances governing this type of work will be complied with whe�her specified hereiri or not.The granting ot a permit does not presume <br /> to give authority to violale or cancel lhe provision of any other state or local law regulating consiruclion or the performance ot <br /> construclion.That I am aulhorized by the owner of this property to perform ihe work forwhich application is made and I comply with the <br /> Sta Contractors La�+ 18.2 �RCW and 296200 WAC. <br /> _ ,? � 7 , _ / <br /> � <br /> Si� uYe f• nedC r �r�� orized Agent Date <br />