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� • <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—v�n�rvv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED'rROM 8 AM TO 4 PM / � C� S�/ <br /> SITE ADDRESS PARCEL TAX I.D.# �PtE MIT p <br /> � �, �V ��.r � �e �'� '�.0`3 0o`1�\ti�����c���`�yor� /� � �� � � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DGSC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ; t � �� �: ��1�0 ���. �� �� �1�� �1 (�� < �a��� � �v• ��zre � t ���,63 � �las s�y .'� �1�� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE �1��. S�y_ j Q��I <br /> J �('�2 E-MAIL <br /> iR CTOR` , ` ADDR C� IT IZI P O <br /> �GS4„�nl�� o�. Nc.� urc,� C.as `�.�15 W. �c,.i,��U I�� �`�G ��`�.0�� LI�.S-3��1-141�� <br /> CONT .LICENSE# � P s Nz t� G q\� L� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �V � % '' �� ` '`� '`�� _Electric �Gas_Other 1��,3'�p U . Q � <br /> WORfCDESCRIPTION 1� r � Z ^s�0,�� I� � w ���� F� r '��cC< , <br /> ��� �-.,�� �� �„��+ rUr'ho.ce � <br /> 1h)t�,��e � � /a� ' 1 ���5 � S �\`�` � oC o �� � � 3T Sett�eMe,.�. <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF FIXTURE OR ITFM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> � Bathtub 1 Forced air systems <br /> !avalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washcr Clothes dryer <br /> Water heater Ran�e hood <br /> Sink(service/badmop/elcJ _ Exhausl(an <br /> BackOow prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> �loor drain Refrigcra�ion <br /> Grease trap _ Woodslove <br /> Roof drains O�her <br /> Olher — <br /> CITY OF EI�ERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify Ihat I have read a�d examined this application and know the same lo be We and correct. All provisions of laws and <br /> ordinances governing�his type of work will be complied wilh whelher specified herein or noL The granting of a pemiit does nol presume <br /> to give aulhoriry to violate or cancel the provision o(any other stale or local law reguiating consiruclion or the periormanca of <br /> cons�ruction.Thal I am aulhorized by ihe owner o(lhis property lo perform the work forwhich application is made and I comply with the <br /> State Conlractors Law 18.27 RCW and 29�200"WJ,kC. <br /> —_i� ////� � 2c� J ' <br /> Signaturc of Owner/Contraclor/Aulh �fYed Agenl Dale <br />