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�, <br /> PERMIT 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 6 AM TO 4 PM <br /> SITE ADDRESS I PARCEL TAX I.D.N PERMIT�I <br /> 'u�� A����t ��� �L��r-A.,� c� i� ��a�=�a� r�o�og-�3� <br /> LEGA LOT NO. �n BLOCK TRACT OR SUBDIVISION N <br /> DESC. Se�� ;\ 1'\(C e--.» <br /> OWNER ADDRESS CITY2IP PHONE <br /> �lev�ti- �uhl�L �t�-h �C-t- 2C'CbI�.���l �kc.� U H� <br /> TENANT NAME CONT��R,SER I a`+ ^�L PNONE � <br /> p � �tav�- 3�ra- �q B <br /> ����-� ��L ��15-��Y�C,� P ' e�a� nn: G� c <br /> �6REs� , � o+p. <br /> coH.u�se r �� � � � ���C.i � o r i e �I e <br /> RES i A � m 45a{�M <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other � 'G� ��`Q� <br /> 1� <br /> WORK DESCRIPTION <br /> CS ��� '�'aC�SE=t�'�L� ��C.Q��i <br /> � ���� � �� � z� ����. ���� � <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. 7YPE OF FIXTURE OR IiEM <br /> Toilet A/C—air handling units <br /> BalhWb Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/barlmop/etc.) _ Exhaustfan <br /> Backllow preventer _ Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain �O��ef � ^�� � � I�,pd(� L <br /> Floor drain Refrigeralion n T <br /> Grease trap W�d$ e _ <br /> _ Roof drains � Other ( Z�� �I y,l <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I havo read and examined lhis appiication and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces goveming this rype of work will be complied with whether speciTied herein or noL The granling of a permil does not presume <br /> to c�ive authoriry to violale or cancel the provision of any other state or local law regulaling construclion or the peAormance oi <br /> conslruclion.Thal I am aulhorized by Ihe owner of this property 10 pertortn the work for which application is made and I comply with the <br /> Sta e Contreclors Law 18.27 RCW d296.200 WAC. <br /> � � <br /> U C,i,C,�- �j c <br /> ignalure o(OwnedContraclor/A horize �Agen Date <br /> , ��Z <br />