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faS'O�-' �5�� <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 /> APPI.ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# I PE IZ I � -0� I <br /> � <br /> 330 ,Go a�o� �/-�e� voy390 - -19'}-oze - oo �I <br /> L[GAL LOT NO. BLOCK TRACT O�R SU/B,/D-IVISION# ���'� �Z ' <br /> DESC. � �Z.9 �� � �.P/at/'c Xci�ra'� y_ 7 7�9 <br /> OWNER ADDRESS CINIZ� � ONE <br /> �-/��.-� P�� ��� ����� �'v�� ��i <br /> TENANT NAME �fCONTACT FOR PERMIT PHONE y25 .ass •aaa 1 <br /> I L"q,y,�,,...d /7 CJDM <br /> ,Jcyyp �WQi7atu-IeW 4'� ' E-MAIL <br /> CONTRACTOR �RES�' -�CITYIZIP PHONE <br /> CONTR.LICENSE# �CI t2�lcnt� �I I 3 L-�� <br /> / <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �ep�ia�a�� _Electric�Gas_Other ��(�(7 <br /> � <br /> WORK DESCRIPTION -�¢���� ¢�� Ld���� ��L� <br /> PLUMBING MECHANICAL <br /> tJO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub X Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> ` � Sink(service/bar/mop/etc.) _ Exhaust fan <br /> � Backflow preventer _ Heat pump <br /> '�. Urinal Unithealer <br /> �' Drinking Fountain _ Boiler <br /> �� Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other — <br /> � ' — <br /> — <br /> CITY OF EVERE7T LOCAL SALES SAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correcL All provisions of laws and � <br /> ordinances goveming this type of work will be comptied with whether specified herein or not. The granting of a pe�mit does not presume <br /> �� to give authority to violate or cancel the provision of any other state or locai law regulating construction or the performance of <br /> I consiruction. That I am authorized by the owner of this property to pedorm the work for which application is made and I comply with the <br /> Stale Contractors Law 7827 RCW and 296.200 WAC <br /> � � �,-7'—rs-b l�/i.J/2. <br /> SignaWre of Owner/Contracror/Authonzed Agent Oate <br /> i- <br />