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� <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.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.� PERMITN <br /> /�'/°l f�ewi��' l�ve �:.C- - ZIr01 SG7 � 1 — D �-"/ <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION 11 <br /> DESC. <br /> OWNER ADDRESS CI?YIZIP PMONE <br /> Pe�� 5 �� v l�ly Ne�;,�;'�� Ati�e. �deref�, t��A `i8ozl 4Zs-Zsy-s�3f <br /> TENANTNAME CONTACTFORPERMIT PHONE tfLS- it��- yy j <br /> ^ 7 I A� I <br /> �OCrY�PS ��I �VPG��:S (..Ci✓Y�'�PS /r� �VeC�.'.S E-MAILIVIiS.�r55@LJ��LC�1. P� <br /> -��N�}fA�: / / / $$ <br /> %ennnt is �/piny j�e WO�'K <br /> CONTR.LICENSE p <br /> USEOFBUILDING (,�,��5}FY�1 l'nIPGY I HEATSOURCE CONTRACTPRICEOFWORK <br /> ��e ���j� .�rCYL' ��Electric _Gas__Other �jQ�� �� — <br /> WORK DESCRIPTION <br /> Nrny���y � wal� si9n. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FU(TURE OR ITEM <br /> � Toilel _ A/C–air handling units <br /> Balhlub Farced air systems <br /> � Lavotory(wash basin) _ Gas piping <br /> Shc.ver Watar heator <br /> Kitchon sink&disposal _ Gas fireplace <br /> Dish�vasher Gas range <br /> Clolhes washer Ciothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mopletc.) _ Exhaustfan <br /> Backflow preventer Heat pump <br /> Urinal � Unit heater <br /> Drinking Fountain Boiler <br /> Fioor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains _ Olher <br /> Other <br /> CIN OF EVERETT LOCAL SALES TAl(CODE IS 7105 <br /> I hereby ceritify lhat I hav�read and examined lhis applicalion and know the same lo be lrue and correcl. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or not.The granting o(a permit does not presume <br /> lo give authority to violate or cancel the provision of any olher state or Iocai lavi regulating wnstruclion or lhe pertortnance of <br /> conslruclion.That I am authorized by the owner of lhis property to perform the work for which applicalion is made and I comply wilh lhe <br /> Slale Conlractors Law 1827 RCW and 296200 WAC. <br /> ��' `c_i < 1� 11 I `1 �00� <br /> � � � ----�- . � ���- <br /> Signa) re of OwnedConlractorlAuthonzed Agent Date <br /> �/Z. <br />