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( <br /> P�RMIT 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 B AM TO 4 PM 6 -�� - �I <br /> PARCEL TAX I.D.# PERMIT# <br /> SITE ADD ESS Q � <br /> �Z �rr�R;✓� �f.�F� � oa���i��o��f�o //ov - G � <br /> LEGAL LOT NO. � BLOCK TRACT OR SUBDIVISION# <br /> DESC. ,'� Ui�co',��cl � l�dd <br /> OWNER ADDRESS CITY2IP PHONE <br /> �Q� �/Ca�i� �naa� 3zz �aa�rt �;),�� ���7Y�c�3 f3�v-/?I/ <br /> TENANT AME CONTACT FOR PERMIT PHONE /�?,s o��� —�7uZ 77 <br /> I��'.'�.7RrY�.+�a2Tl/ E-MAIL�k�TaRKSGX�� ,c� <br /> c N T R Av� s�. <br /> �At�� +��i/��2s N-I,c�1�c. 7�o9slos`'�`' Srr��a��s��T�90 `�'s-a3�- <br /> CONTR.LICENSE#�,��� �Q N� <br /> // <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �/ 7�j,,�� — <br /> S�e _Eleclric Y Gas_Olher <br /> / CG6� �l�'o.� �d.�L '� <br /> WORK DESCRIPTION /L-��i3G ' (�WY 6 �Q6,e �-)C�C�� � �� �' � "�� <br /> � �z`nC% �7- ���cG� �f.��� ��-��-2�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM1t I <br /> NO. TYPE OF FIXTURE OR ITEM ' <br /> A/C—air handling units <br /> � Toilet porced air systems � <br /> � Bathtub Gas piping <br /> Lavatory(wash basin) � Waler heater <br /> �_ Shower Gas lireplace <br /> � Kitchen sink&disposal Gas range <br /> Dishwasher � Clothes dryer <br /> � Clothes washer � Range hood <br /> _ Waler heater �_ Ezhausl fan <br /> _ Sink(service/badmop/elcJ Heat pump <br /> Backllow preventer Unil heater <br /> _ Urinal — gailer <br /> _ Drinking Fountain Refrigeration <br /> Floor drain Woodslove <br /> Grease trap Other <br /> Roof drains — <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing Ihis type of work will be complied wilh whether specilied herein or noL The granting of a permil does not presume <br /> to give authority to violate or cancel the provision o(any olher st�te or local Iaw regulating construction or the per(ormance of <br /> wnslruclion.Tha I am aulhorized by the owner of lhis property lo perform the work for which appiicalion is made and I comply wilh lhe <br /> Stale Cont ct s Law 18.27�W and 296.200 WAC. <br /> ,��������i�i�� l�-� '�/ ► <br /> Signature o(OwnedConlraclodAulhonzed Agenl Dale � <br />