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r — <br /> . <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <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 <br /> SITE ADDRESS PARCEL TAX I.D.N P M T 7�/�/ <br /> � a / <br /> LEGA LOT NO. BLOCK TRACT� ./ <br /> DESC. SE �O � � � ?GL�Ci • <br /> n oa ADDRESS CITY/LP PHONE YZS' <br /> 1�aldens�ond �Suo 6• LI2.S+evens ��� �P� <br /> L.�.C• 'P�cl . #ZG� �a.everts c�3�•0573 <br /> TENANT NAME CONTACT FOR PERMIT ,/lsi�3/ ' Q � <br /> �r� '� ,I '• "�1 � �O •<^-.1 >.� <br /> CONTRACTOR AODRESS C�TYlLP PHONE <br /> CONTR.LICENSE R •� 1��\• - W+� t'�,r',��� 1,+ '� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��� Eleclric Gas Other <br /> WORK DESCRIPTION <br /> �9 0� �p��c ��-rti'.�.�,C.J!��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> [O Toilet AIC-airhandlingunits <br /> � Bathtub � Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> � Shower � Water heater <br /> � Kitchen sink 8 disposal Gas fireplace <br /> � Dishwasher Gas range <br /> �, Clolhes washer Clothes dryer <br /> Laundry t2y Range hood <br /> Sink(servicelbarfmopletc.) �¢ Exhaust fan <br /> Backflow preventer Heat pump <br /> Unnal Unit heater <br /> Drinking Fountain / Boiler <br /> Flaor drain V Refrigeration / <br /> Grease trap Woodstove ,/ <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J106 <br /> I hereby ceritify that I have read and examined lhis application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces goveming this type ot work will be comp�ied with whether spedfied herein or not.The granting of a pemiit does not presume <br /> to give authorily to violate or cancel the provision of any other stale or Iocal law regu�ating wnstrudion or the peAortnance af <br /> consiruction.That I am authorized by the o er af this property to perTortn the work for which appliwlion is made and I compty with the <br /> Stat Contract L w 18.2 QW and 200 WAC. <br /> 1 � <br /> Si nature o Owned on ut onz Ag nl Oat <br /> �I� <br /> � <br />