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i � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 a �-I 7--� <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �L�� <br /> SITE ADDRESS W PARCEL TAX I.D.N PE�R IT K <br /> 1 . � ,c�,�r,���.�, �� ����y��•����re���ir�-�- �W- <br /> LEGA LOTNO. BLOCK TRAC/TORSUBDIVISIONp <br /> DESC. �O G�L°C � `CJ 7' t � <br /> OWNER ADORESS CITYRIP PMONE 3��.I a43 <br /> [:,� �� ��-1;V � il,l �r��/ `�7// I.�! l�lrv�w�(r���./ ���i c�rr- -- <br /> TENANT NAME CONTACT FOR PERMIT �) PFiONE (� <br /> � �Q/` �c2v�1l� EdAAIL �U�i 7�5 (�Cf 7 / <br /> Ir%�L �/\��r-- <br /> CON7A.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> f�77_. _Electric _Gas_Other <br /> _ / <br /> WORK DESCRIPTION <br /> �F �-C-��/-)�! � e:'Xlr>7�I�JL-� ��t-'-'�f'N/, LE'z c�L_ l.�l'r /! <br /> (�iV�F��7?- D�� 1'"L-' l��/�' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TUHE OR ITEM NO. TYPE OF FO(TURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas lireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/etcJ _ Exhaust lan <br /> Backllow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily that I have read and examined this application and know the same to be truc�and correct. All provisions of laws and <br /> ordinaces governing this type ot work will be complied with whe�her specitied herein or noL The granting of a permit does nol presume <br /> to give aulhoriry lo violate or cancel the provision ol any olher slate or local law regulating construction or the pertormance ot <br /> construction.That 1 am authorized by Ihe owner of Ihis property to pedorm the work lor which app�ication is made and I comply with tho <br /> Statc Contractors Law 1827 RCW and 296.200 WAC. <br /> �(nv5'� .R- �'Slt��� <br /> SignaWre ot OwnedContrecrodAuthorized Agent Date <br /> II � <br />