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, � <br /> � � P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICFS <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.evereriwe.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM H —I S�� <br /> SITE ADDRESS PARCEL tAX I.D.M PERMR/ <br /> LO .�Ew i T�4✓ �T drr�'�' G� vo 00 � O2 I _ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDMSION/ <br /> DESC. <br /> OWNER ADDRE33 CITYRIP PHON <br /> .sf�+'�r-,dE.�rEG /b w� .✓� s�.E aD .a�vo�✓ <br /> 7ENANT NAME CONTACT FOR PERMR PHONE ��] . �/ , G 'F, <br /> I �evGE Jo�!'�✓.s7e�✓ �,JN�M S T►h ��e�7..+.c.a <br /> � IT4211� <br /> �"I4G� len.�yr•ric.¢s�a�'.r, ��vc- G��e�, /fif�y,�/L <br /> CONTR.LICENSE N <br /> USE OF BUILDING / HEAT SOURCE I CONTRACT PRtCE OF WORK <br /> �,�yLE 8��J� / Electric _Gas_Other � +�, C�►• O'a <br /> �-- <br /> WORK DESCRIPTION G.�.�� <br /> %r.sT�ru ��.��t�Na2 0.✓ ce�F �� ,gc v4• tin- .sy <br /> E'�R�1i,✓4 ci✓�y �o h/�EI� . <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub 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 /> qothes washer Cbthes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust(an <br /> Backflow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refigeratlon <br /> Grease trap Woodstova <br /> Roof drains Other _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriliry that I have read and examined this application and know the same to be We and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specifled herein or nat.The grailing of a permil does not presuma <br /> to give autho 'ly to ' late or cancel lhe provision oi any other stale or local law regulaBng wnstruction or the perfortnance of <br /> construclio .T t am a thorized by the owner of lhis property to perfortn the work for which application Is made and I comply wilh tlie <br /> Slate Con Law 1 .27 RCW and 296200 WAC. <br /> '� �Y 0 <br /> SignaWr of OwnedContraclodAuthorized Agent Date l/v <br />