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� <br /> ,- <br /> P RMIT APPLICATION <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 8 AM TO 4 PM �.. a 6-aI <br /> SITE ADDRESS PARCEL TAX I.D./ PERMIT t <br /> �'J�� Pit��'� d�`1 O.isvv ' � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION M <br /> DESC. 3 S � <br /> OWNER ADDRESS CITV2IP PMONE <br /> ��O..�s�.� v�� dox �97A fi�P�r�T`T r.u� ��.Z�jo <br /> TENANTNAME� I CONTACTPORPERMR PMONE 7'�jS-�jO- 7 »� <br /> �.yr-e- E�AAIL QiC.KL.f.d,uif.�.-�SkLn <br /> �`O c'.r <br /> Sti..>� <br /> CONTR.UCENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �'�� ✓Electric _Gas_Olher ���Qy-o <br /> WORK DESCRIPTION A / <br /> IQLFr„v s,�w�Ec �<.....ytt�1 G.-,/o/,.,�, 74�nc/ <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FIXTURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> _ Toitet PJC—air handling units <br /> _ Balhtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> _ Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) � Exhaust fan <br /> Back(low preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor dra�n Rehigeration <br /> _ Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES iNC CODE IS 1705 <br /> I hereby ceritily that I have read and examined lhis applicalion and Ar.ow lhe same to be true and correct. All provislons of laws and <br /> ordinaces governing lhis type o(work will be complied with whelher specified herein or not.The granting of a pertnit does not presume <br /> lo give aulhority to violate or cancel the provision of any olher stalc or local law regula6ng constnictlon or lh9 performance of <br /> conslruction.That I am aulhorized by lhe owner o(this property to peAorm the work for which appllcation is made and I comply with the <br /> Slate Conlr�ctcrs Law 18.27 CW and 296.200 WAC. <br /> %'z'��r� z�� /- ,>�/-v `� <br /> SignaWre oFOwnedContractor/Aulhonzed Agent Dale � <br /> � <br />