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t <br /> �ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857–www.Pverettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �iJ`'/ L'� <br /> SITE ADDRESS PARCEL TAX I.D.i1 PE � <br /> G I � � CG�-J��3 if! ��F , �UJ��S !.b ���� ��7-G n <br /> LEGA LOT N0. �, BIOCK TAACT CR�JBDIVISION M <br /> DESC. t�c� <I 1 Ot� D-��p I���•.;� N�r2si- D1 ✓ � <br /> OWNER AUDRESS CITY2IP PHONE �j2y-�io- ISI <br /> M� ' I �z�c/ 0 �,��.�;3��, Zrl�, Ce��,�a�a AVr"= ������, �Pr�,3 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE AZ}-7 j G`'Z 1 SI <br /> I ! U`L�,J�y-'.�?,�, S�DEr�ix��, z E�MAIL'TMECl1'i 5C`/Ew 1�4C� V:J.JL� <br /> ��� <br /> (�,.. 7'I�r= L+ v4=tr GL'r.lS j. � . L �.In1 w�C 1� �2�G` � G <br /> COMA.UCENSEp ��'�� R �is r_Lp7J �Z 1�, y. 1�� ( �7 S � <br /> 1 �(1�� c_r��t49M 1 ��'�e��7 <br /> USE OF BUILDING HEAT SOURCE NC �_ CONTRACT PRICE OF WORK <br /> 7 �` (�h2,�"� �/ST�!`,k�� _Electric _Gas_Othor 2�j�Gj�.n <br /> WORK DESCFIPTION <br /> �U��l`�'�RJL��IQIJ :%t- NI�U� D�TACl�t-1�. 2 -C�t�2. C,h2�E. -�c i2rF�Ac.E �X�5ri;,�� <br /> D_ ,—a c.,a�—a c'-,R rAc,F_' f�=P110 C,k'1 s�t,-t^C <br /> PLUMBING ECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � �. <br /> Toilet A/C—air handling uni�s <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) __ Gas piping <br /> Shower _ Water heater <br /> _ Kitchen sink&disposal _ Gas lireplace <br /> Dishwasher _ Gas range -� � ���) I' <br /> Clolhes washer _ Clothes dryor � � G�� � <br /> YJaterheater _ Ranflehood �('V� <br /> Sink(servicelbadmop/etc.) _ Ezhaust fan <br /> Backllow preventer _ Heat pump <br /> Urinal _ Unit hoater <br /> _ Drinking Foun�ain _ Boiler <br /> Floordrain _ Refrigeration <br /> Grcaso trap _ Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify�hat I have road and examined this appiication and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will bo complied vnlh whether specifiea herein or not.Tho granting of a permit does not presume <br /> to give authority to vioiate or cancel tho provision ol any other state or loral law regulating construction or the performance of <br /> conslruction.That I am aulhorized by lhe ownor of lhis property to peAorm tho work(or which application is made and I compty with the <br /> State Contraclors Law 18:27t RCW and 296.200 WAC. <br /> u. 1 ��I..,. - l 1 O�i <br /> naNreot or/Co actodAuthonz gent Date �/' <br /> �Z <br />