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PERMIT APPLICATION � <br /> CITY OF CVERETT FERMI"f SERViC;ES <br /> 3200 CEDAR Sl"REET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 �'���� <br /> SITE ADDRESS �'"""�' `�"�vb PARCEL TAX I.D.# PERMIT-#7 <br /> .� 1 �. � �.�. K� 1-(�:yh��S ��. UO�{4:3�Coo0o3c�c7 � � Y�CXX� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DFSC. 3 CC:O � - (`p ' ' � _ <br /> OW/NER / //, ^ ADDRESS CITY2IP f?HONE <br /> %-7c.� .� ��"�< -( �-^'(+...a..,. 5/0..,) 3� �-`� �.�<. L�..� C-✓r-� !( (.J4 `��r� ' 70/•$7�/Y <br /> «S3.�c'� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRE55 CITYIZIP PHONE <br /> CON'R.LICENSE N J VJ'��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� � �Electric _Gas__Ofher <br /> WORK DESCRIPTION f� L� t .. .( E�� � � r� � �+'� <br /> /Cr �,/�... 6 K: .. <br /> �z��,iu « <.;� f.�.- ti.,_. �.. ;- <br /> _ G <br /> u-E � 1�-c«.. ., c�f \ f ' 1. �.J .J. c�c•�S <br /> ) <br /> PLUMBING MECHl�NICAL <br /> NO. TYP[Of FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Balhlub Forced ai!sys�ems <br /> ) ✓ _ Lav3tory(viash trasin) Gas piping <br /> y,��,/ Shower �� Waterheater <br /> � t✓ Kitchen sink &disposal _ Gas fireplace <br /> � Dishwasher asrange <br /> Clothes washer 1 Cloihes dryer , <br /> Waterhealer angehood �«`"-"� �"� '"'���"'�� <br /> Sink (service/bar/mop/etc.) ��� Exhaust fan <br /> 8ackflow preventer _ Heat pump <br /> Urinal Unit heater <br /> I � Drinking Founlain = Boiler <br /> Floor drain Refrigeration <br /> I __ Grease irap _ Woodstove <br /> I _ Roof drains _ Olher <br /> I __ Olher _ — <br /> I —.� —.�� -- � - <br /> � CITY OF EVERETT LOCAL SALES TA%CODE IS 3705 <br /> I — <br /> I hereby certify Ihat I have read and examined this application and know the same lo be true and correcL All provisions n(laws and <br /> I ordinances governing ihis�ype of�vork will be cornplied wilh whelher specified hzrein or not.The granting of a permit do�:s not presume <br /> lo give aulhorily to violate or cancel lhe provision of any olher slate or�ocal law regula�ing cansiruc�ion or lhe performance of <br /> construclion.That I am authorized by the owner of lhis property lo perform the work for which applicalion is made and I comply with lhe <br /> ! S�a�e Coniractors Law 18.27 � 2nd 29G200 WAC. <br /> � <br /> �_ � iJ'-7 //.� �:�JiO <br /> Signature wn�dCoi traclodAuthoriz d Aoen� ate <br />