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- � <br /> � PERMIT APPLICATION � <br /> CITY OF EVERETT PERhIIIT SERVICFS <br /> 3200 CEDAR STREST, EVERETT, �/JA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � _as-0 6 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> i ��� c �11� �.>r . � � � oG oc��oc7 �'�:.�k�k . .,�3 <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. 1 � �}�jzL�� �� It� <br /> OWNER ADDHESS CftY21P PI10NE <br /> Z v�r�o.�C�1iJ�, �v,ve�s-h1'�e ��-1-{�, Z �� .�� � o� i <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> �;� �o,�t CG2c � 1-�-6 j CCMS�C t� 1��c2� 3�,� � �V1Ctr�(S�i �lk � t�:h ��1�'a� �i <br /> CONTR.LICENSE7J EC<< I� CC� �� � � N ` <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �, ;-) �Electric�Gas_Other � I <br /> WORK DESCRiPTION � I <br /> ���1,� L� ��I f`IC:��c t"Cl�l� il�l �PS��1 t r�Cs:—� I <br /> - s; .�3a i I <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FI%TURE OFi ITEM NO. TVPE OF FIXTURE OR ITEM <br /> .;j Toilet Ar'C–air handiing units I <br /> ;� Bathtub � Forced air system; <br /> � La�•31ory(wash basin) � Gas piping � <br /> � Shower _� Water heater �'I <br /> Ki�chen sink 8 disposai Gas fireplace <br /> � Dishwasher Gasrange <br /> qothes washer �� Clothes dryer <br /> � Water heater I fiange hood <br /> Sink(eervice/bar/mop/etc.) �:._ Exhaus�fan <br /> Backflow prevemer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains __ Other_ <br /> Other <br /> CITY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity that I have read and examined this application and know the same to be true and correct All provisions ot laws and <br /> ordinaces governing this type of work will be complied with whether specified herem or nol The granting or a permit does not presume <br /> to give authority to violate or cancel the provision o(any other slate or IocaFlaw reg�lating construction or Ihe performance of <br /> consiruction.That I am authorized the owner o(ihis property to perfortn the work for which application ie�.made and I comply with the <br /> Stale Con�raclors Law 1827 RCW a d 296.200 WA . <br /> � 7 ' <br /> j, i � - <br /> Signature of ne� oNractodAu orized Agent Oate <br /> i �,J ��> <br /> - - �.�:. �-� -,.,,.;:;,��-�,,~`s <br />