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( j .. <br /> PERMIT APPLICATION <br /> CITY f F EVERETT PERMIT SERi/ICES <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 Q '- J3 -�IC7 <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT tF <br /> 6 Ever reen Wa ��d �' Zti cIC�O � /oC�� dl�— <br /> LEGAL LOT NO. OCK TRACT OR SUBDIVISION i <br /> DESC. <br /> OWNER ADDRESS CITYZP PH NE <br /> - � � 1 -�ti �6� 3zi - 78� <br /> TENANTNAME�U', ��NS�1N �O CONTA'FORPERMIT e S'"L SNo�PHONE (10��70 Z <br /> � '� <br /> �TtFA � /'7(���Q I �N� F �G�u.�s � uk4oul19acCaa,SQC'� ni� .Cvw <br /> .�'n�� S=�r+s /9io� N�r 9%' T�79 �-y�,,vc�rd, � ���6 �ZS-�7�co 2 <br /> CONTR.LICENSE� <br /> `�.Y�—'c`-0��-� 9�L) 7'17 ,t./_� . (. ?.- � <br /> USE OF BUILDING I k1=AT SOURCE CONTRACT PRICE OF WORK <br /> �^L-C–�i I Y E6ncGic__Gas_Other ��r��I�U y' <br /> WORK DESCRIPTION <br /> T"s�-�.�► 3 c�,�„r., �.�.i� Q-� w<<i� Sra�Ps� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toiiel A/C—air handling units <br /> Bathtub Forced air systems <br /> _ Lavatory(wast�basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 ditposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Waler heater Ranye hood <br /> Sink(servioe/barlmop/elc.) _ Exhausl fan <br /> Backflow praventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drelns Olher <br /> Other <br /> CITY OF EVERETT LOCILL SALES l'AX CODE IS 3705 <br /> I hereby certify that I have read and examined this application and know the same to be lrue and correct. A�I provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.The grantlng of a pertnit dces not presume <br /> to give aulhoriry lo violale or cancel lhe provision of any other state or iocal Iaw ragulaling construction or the pedortnance of <br /> construction.That I am aulliorized by the owner of lhis property to periortn the work for which application is made and I comply with lhe <br /> State Contradors Law 18.27 RCW an 296200 WAC. . <br /> -�� � tti�--�_ �/(L � �/O <br /> Signature o edCoNractor/Aulhorized Agent Date II <br /> Z <br />