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I <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E`IERETT, 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 ADDRESS PARCEL TAX I.D.# PE��� � _ �I� <br /> I cs v 2 I-1�� (,,.,,�4 9 Sf� l C S <br /> LEGA LOT NO. BLOCK TRACT OP SUBDINSION N <br /> DESC. <br /> OW ER ADDHESS ITY21P r'✓1 PHONE �•�c� _ <br /> J V�J <br /> ��k G'w��� V <br /> C�.��<_ D� .> (c �,,,,��-} Gzo �1. F3��...a l�l� `I � zo3 -z��-� l �'7 <br /> TENANT NAME CONTACT FOR PERMIT P�a+E So 9 - 9 4�-16`i � �/ <br /> �c.� C'��� �. L n �,.. s 5 <br /> I I.) U�� ��:ilnvtc� E�NIAIL�C�Cw��ct�N C.o"._"�'�; C�1 T <br /> �04.�.� Co�.i�'. r� / S..z,{`��o �7. p / <br /> CONTR.LICENSE M � Z G IL�. 7`� � S�w�T �i�� JCJ I-� I Q �( S� <br /> 3oHNs �- 'X- ' l3UL � <br /> USE OF BUIIDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �c� <br /> �„�✓N� y� � , �r 5 _Electric �Gas_Other ` ����U — <br /> / <br /> W07KDESCRIPTION �j�, ` �� inov- ��e,���•.,� "$c--�e �� G•�-l� , ZwS ��( ( �aG'cO�v�L�. <br /> �,� ,� � �(-� � �« w�r ti, ,:.a��+ � -�lab_ c.; �....,.��., <br /> �,_r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM NO. TYPE OF flXTURE Ofi ITEM <br /> Toilet _ A/C-airhandlinguni�s <br /> Bathtub _ Forced air systems <br /> Lavatory(wash oasin) ____ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water heater ._ Range hood <br /> Sink(service/bar/mop/etc.) __ Exhaust fan <br /> BacMlow preventer __ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Founlain __ Boiler <br /> Floor drain _ Refrigeration <br /> Grease Irap _ Woodslove <br /> Roof drains _ Other <br /> Other _ — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhat I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces govorning�his type of work will 6e complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give aulhority to violale or cancel Ihe pro��ision of any other state ur local law regulating construction or the performance of <br /> conslruction.That I am authorized by t ner ot this property to perform ine work for which application is made and I comply vnth Ihe <br /> State Contractors La �8. RCW-a �.200 WAC. <br /> _ l� �b���—V <br /> Signature of OwnedContractor/ orized Agent Date � <br /> Z <br />