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�ERMIT APPLICATI��N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �- a2� �D <br /> SITE ADDRESS PARCEL TAX I.D.�{ PERMIT R <br /> i �;�- ,���. � 3916�yo3 f o� �o�--or� <br /> LEGAL LOT N . BLOCK TRACT OR SUBDIVISION N <br /> DESQ Z �<y� , <br /> OWNER u AD�RESS CITY2IP PHONE <br /> M 0.�A vh o�d� � .�� n� `\Za ���J l 7� L �ccv�11}lU¢. G v �yLi��9—3��1 I <br /> 7ENANT NMAE CONTACT FOR PERMIT PHONE�y�� ZS9 -3�`I <br /> J\v�'1 �,Y1N J�VY� C.1t�1e✓ E*IAIL /1� I ZL'f�Ni'�-•(A' <br /> _� � <br /> J� m 7�c.6�e✓ l7/2 �}cw� N-}4v2. �%�l - �'/2��z,Sg - 3�yI <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRI�E OF WORK <br /> / / �L.. <br /> �es;-_ ���j �o��, �Electric �[c�as_Other Z��� <br /> � <br /> WORK DESCRIPTION `� <br /> ��u►�b;n9 �ue� ki +���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OP FO(TURE OR REM <br /> Toilel AIC–air handling units <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> � Kilchen sink&dis�osal _ Gas fireplace <br /> � Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> � Sink(service/bar/mop/etc.) _ Exhaust fan <br /> BackFlow preventer _ Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> 9/ Floor drain • __ Refrigeration <br /> � Grease trap _ Woodstove <br /> _ Roo(drains �� _ Other <br /> Olher y'��""''� <br /> _ QY(Q Si" I� — • <br /> C�TY OF EVERETT LOCAL SALES TA7C CODE IS 9105 <br /> I hereby ceriti(y thal I have read and ezamined this application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specitied herein or not.The granling oi a permil does not presume <br /> to give 2uthonty to violate or cancel ihe provision of any olher stale or Iocal law regul3ting construclion or the performance of <br /> construction.That I am authorized by Ihe owner o(Ihis�:roperty to peAorm lhe work for which application is made and I compiy with lhe <br /> State Contraclors Law 78.27 RCW and '196.200 WAC. <br /> �--� `` 7/21 /A� <br /> r/AulhorizeC 1gen1 Da <br />