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„ <br /> PEr2MIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-757-8810—FAX 425-257-8857—w�vw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �7C;,-(,C`�� <br /> SITEADJRESS I (� PARCELTAXI.D.# p Os,�c� —OZ� <br /> �(d—I� �O "}' YtVG 47 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER AUDRESS CIN21P PHONE Cu ' NZS-22c' G(O <br /> C�A� Io M/\`F—!"C �- S �Z�CI HO�T I�V� �V�Q—�� �'�Zo� H•.N25 -2 _ <br /> TENANTNAME CONTACTFORPERMIT PHONE �'flR <br /> CONTRACTOR ADDRESS CIN21P PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �����' a � 5��� � _Electric k Cas_Ofher <br /> WORK DESCRIPTION a �,,,�.�J,�.. tn-a� S —�� � VJe�—'r'� � �� �'`�b` <br /> ,..eQ b'1o� � �1�c., � ��'”" � <br /> �'IooYs� -I,�,�,��;,�i w�..k, ��►„�ow- ,,.-�,4 s��-a�� sl��, z S:V,,t�>, i�����. <br /> PLUMBING MECHANICAL <br /> NO. TYPE 9F FIXTl1RE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> 1�_ Toilel _ A/C—airhandlingunits <br /> ��_ Bathtub _ Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> y_� Shower _ Walerhealer <br /> Kilchen sink&disposal _ Gas freplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) � Exhaust fan <br /> Backllow prevenlcr _. Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify lhat I have read and examined this application and know Ihe same lo bo true and correct. All provisions of laws and <br /> ordinaces governing this rype o(work will be complied wilh whether speci(ied herein or noL The granting of a permit does not presume <br /> to c�ive aulhorily to violale or cancel the provision of any olher state or local law ree�ulaling conslruction or the pedormance of <br /> construction.Thal I am authorized by Ihe owner of this property to pedorm the work for which applicalion is made and I comply with tho <br /> Stale Contraclo s Law 18.27 RCVJ d 296.200 WAC. <br /> �� � z � �� <br /> Signalure of OwnedCon a or/A thorized Agent Date �/� � <br /> ��� J <br />