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� <br /> ,�.�� � �� �' '' � <br /> �` �"1� � `'� RERMIT APPLICATION <br /> �` � CITY OF E�'ERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> �� APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /�J�.��--d� <br /> SITE ADORESS PARCEL TAX I.D.# P RMI <br /> "1• i�S l-lR os�fu� l, ��b 20'� C'� o -r'-,�>. � o `-1� (vo � r D -(�o� <br /> LEGAL LOTNO. BLO K TRACT <br /> DESC. <br /> OWNER ADCRESS CITY/ZIP PHONE l..l"Z <br /> � ��k�..cu-r Ci�sh,rw�..-� �lti�`. ��.�wr 1,..�G--+.� 4�� qYz�3 3s3- �4szy <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> (�1� I ��l N.-� W""."1 ��- ��6C�O fl�l`S-6 5 g � <br /> CONTRACTOR � � / ADDRESSl�SJ,� ��� '���`-��Gcinmr PHONE 4��` — <br /> �VAS�+i��,��rt-,� ���i i� � o <br /> �{�1�c,%iLy C y/'C���t� f J 5�y7���� <br /> � �CUAsidIF�`%����,'r �'1�-�b `�'8'��3Y <br /> USE OF BUILDING I — HEAT SOURCE �� CONTRACT PRICE OF WORK <br /> Electric Gas Other � �3� � <br /> WORK DESCRIPTION �r1..�� � �, /11�`� � �^ J �E� <br /> v (-/ I �.�3.-w-e� <br /> l <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXNRE OR ITEM NO. NPE OF FIXTURE OR IT[M <br /> Toilet A/C–air handling units <br /> � Balhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> _ Kflchen sink&disposal �� „ _ Gas fireplace <br /> Dishwasher � Gasrange <br /> Clothes washer _ Cbthes dryer <br /> Laundry iray _ Range hood <br /> Sink(servicelbarlmoplelc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Retrigeration <br /> Grease trap _ Woodstqve <br /> Root drains I , _ Other_ <br /> � Other�y�„a l FA 9-L1�..Q.4.. — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 7105 <br /> I hereby ceritify that I have read and examined this application and know lhe same lo be true and corred. 411 provisions of laws and <br /> ordinaces governing this rype of work will be complied wlth whether specified herein or noL The granting of a permit does not presume <br /> to give authonty lo violate or canc.l the provision o(any other stale or Iocai law regulating consWction or the perfonnance of <br /> construction. Thal I am aulhonzed b��the owner of this property to perfoi m the work for which application is made and I wmp�y with 4he <br /> S�a�Coniradors Law 1827 RCW and 296200 WAC. � <br /> \ <br /> ` ---� .� <br /> Signature of wned ontractor/A� ized Agent -- -- —Date -- ---- ^ <br />