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-� � <br /> P�RMIT APF�LICATIO`�l <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everethva.org �03 -D� <br /> �� n APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM LUU /�� "�I <br /> � <br /> SIT ADDRESS PARCEL TAX I.D.# P MIT N <br /> '�� /�fZ,,i�,�-� CZ.c% c�y o7 o e� oo/o v n;o/ �25� <br /> LECAL LOT NO. BLOCK1 TRACT . � � I � n �� �� <br /> DESC. J : r � (' U.)� 0.!f.f�I <br /> pyy ADORESS I PHONE �O r� � <br /> .�n,2��'�r ,�����,��� � /GS//- Y/�,��i�.�'���,� `' <br /> TENANT NAME � CONTACT FOR PERMIT PHONE 3��[�.�Z7 � <br /> ' , ,�..._ �" , , , . .� �25�344'l,f/ <br /> TRAC OR DRES IZIP P"ONE <br /> j�"a.c.� jCr��'-��.`���� yz�/-�� �'����: ,�'�".'a`�•�y1S�zs�3�/z�z <br /> CONTR.LICFNSE p A/�/ � �G C� • � , � ` ' , <br /> (.c.f� O/Z <br /> USE OF BUILDING HEAT SO RCE CONTRACT PRICE OF WORK <br /> ��11� i�' �'c� ft�,-�' /�% — — — � 2 73�/o I� <br /> 7 ' Eiectric Gas Other ��� b��-' <br /> WORK DESCRIPTION <br /> ���w ��z5��'��`7 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> r <br /> Toilel � A/C—air handling units <br /> Z Bathlub : • i Forced air systems <br /> � Lavatory pvash basin) I-� f�. � d' Gas piping <br /> � Shov.�er � �� L Water healer <br /> � Kilchen sink&disposal � Gas firepiace <br /> / Disliwasher � Gas range <br /> / Clolhes washer _L Clolhes dryer <br /> �_ Water healer � Range hood <br /> � Sink(service/badmop/elc.) � Exhaust fan n�C( ' <br /> / Backflow preventer � Heal pump <br /> � Urinal Unit healer <br /> •-t? Drinking Fountain Boiler <br /> �- Floor drain Re(rigeration <br /> t' Grease trap � Woodstove <br /> _� Roof dreins _ Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> t 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 governing lhis lype of work will bo complied with whelher;pecified herein or not.The granting of a permit does nol presume <br /> to 9ive aulhority to violale or cancel lhe provision of any olher stale or local law reguiating consWction or lhe peAormance o( <br /> conslruclion.Thal�am aulhorized by tho owner of this property to perform lhe work(or which apptication is made and I comply t+ith the <br /> Slale Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> ��l� t XS<< '�'�/1�� l�� '�� ,�� <br /> Signature of OwnedContractor/Au orized Agenl Date <br /> � � <br /> �---- -- �� �c9.5 � � <br />