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P�RMIT APPLICATIUN <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � � �� �:�Lh�SGI� ii"��� ��) i0 00 � � �a-� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> oesc. ,3U 3 I 3 �. .� E/W/:S � <br /> OWNER ADDRESS CIN/ZIP PHON a� �� �- Sq <br /> �7�mv �y i-w�N.�aa,�� �,�ck�4� r� qy� E�E�cTT w,� ��.��3 <br /> TENANT NAME CONTACT FOR PERIdIT PHON �� ��q.5 q 5� <br /> �r• �on�y ,—�o�?NE E-MAIL i <br /> CONTRACTOR ADORESS CIN/ZIP PHONE <br /> CONTR. LICENSE# <br /> USE Of BUILDING HEAT SOURCE CONTRACT PRICE �F WORK <br /> �� ' �� �� ( �� �� Z( Eleclric _Gas_Other ��f 7�� _ <br /> WORK DESCRIPTION <br /> !" i � �� Cls �� ,I . 6LC 7 ,9/�i!< </ I�LS I �Jt .� cc <br /> I "���� 1 %� I � t X <br /> P�UMBING MECHANICAL I <br /> NO. TYP��OF FIXTURE OR ITEh1 NO. TYPE OF FI%TURE OR ITEt.1 <br /> ,3 Toi�el A/C–air handling units <br /> �'� � Bathtub � Forced air syslems <br /> I � Lavalory (wash basin) _ Gas piping <br /> � ;� Shower _ Water heater <br /> � �_ Kitchen sink 3 disposol _ Gas freplace <br /> 3 Dishwasher Gas range <br /> ,�_ Clolhes washer � Clothes dryer �' uN� r /S <br /> 3 Waler heatcr Range hood �Df-'LE� /� <br /> Sink(service/badmopletc.) �� Ezhausl fan �� <br /> Backflow prevenler Heat pump . <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler LG(,N�–i't „nl r r N,� s <br /> Floor drain Refrigeralion <br /> I Greasetrap _ Woodslove ���L �CA�y'S <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I <br /> I hereby ceritify that I have read and examined this application and know lhe same to be Irue and correct. Ail provisions of laws and I <br /> ordinaces governing this lype ot work will be complied with whether speci(ied herein or noL The grantiny o(a permil does nol��-��-sume <br /> to give aulhority to violate or cancel the provision of any other stale or local law regulating construction or lhe periormance of <br /> construclion.That I am aulhorized by the ok�ner of this property lo pertorm the work for which application is made and I comply with the <br /> State Conlraclors Law 18.27 RCW and 296.?00 WAC. � <br /> ;���I�l ��h� r��� v7 <br /> Signature— o�f OwuerlConlractor/Authorized Agent Da e <br /> �Z I <br /> � <br />