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P�RMIT APPLICATIt�N <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 /> APPIICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM 3 �/(� —Q� <br /> SITE ADDRESS / I �'v� �JU e- PARCEL TAI(I.D.• PERMIT/ <br /> ✓e.i'a �C , <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION N <br /> DESC. <br /> OWNER ��� L���n Sk� ADORESS CITY2IP PNONE <br /> 7ENANT NAME CONTACT FOR PERMR PHONE <br /> EdANL <br /> . � �C✓` ��'^ i�^,S 0� )JC'✓Vf.�w S^�ut s /�o�S <br /> CONTR.LICENSE N A'/�h P'K9 ?Q 6� ��a I CI 3 � <br /> 1 / J <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas Other <br /> WORK DESCRIPTION (�oL�s (� � H ��4 L`hQ S e ��✓' � /-� S <br /> 1� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF F URE OR ITEM <br /> a� Toilel _ AIC—air handling unils <br /> Balhlub Forced air systems <br /> a.� Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Cbthes dryer <br /> Water heater Range trood <br /> Sink(service/bar/mop/elc.) _ Exhausl fan <br /> Backilow preventer _ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Bofler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify that I have read and examined this application and krww the same to be true and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specified herein or not.The granting of a pertnit does not presume <br /> to give aulhorily to violate or cancel lhe provision of any other slale or local law regulatlng constructlon or ihe perfortnance of <br /> consiruction.Thal I am authorized by Ihe owner of�his property lo perform lhe work for which appllcation is made and I comply wilh lhe <br /> StaleContra���7�Wand29620�� �' �U✓� � <br /> Signaluro of Owned onlraclodAuthonzed Agent Date <br />