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� P�RMIT APPLICATI�►N <br /> CITY OF EVERETT PERMIT SERWICES �� ��� <br /> 3200 CEDAR STREET, EVERETT,WA 9E201 CO 9��-D2� <br /> 425-257-8810-FAX 425-257-8857-vwvw.everettwa.org -� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �.�� :<- � <br /> SITE ADDRESS /O / PARCEL TAX I.D.R PERMIT/�- <br /> LEGA L NO. .BLOCK 7RACTORSUBDM810NR — I <br /> DESC. <br /> �R ADDRESS ���,� CITY2IP PMOIIE <br /> �� �i�'� /��-- <br /> — � " GLC �.r7 a�tT ifdr .�30 7x -Gu�� <br /> TENANT NAME /CONTACT FOR PERMIT PH �� '��� ���� <br /> I Vlc/}P�J GlJie�rLciNs � e�r�a. <br /> �� ��T �h�,�/fcr�i/tscCG rof�y /�'•for eit�, 9�do� 3�,77a -c�a7p <br /> coarR.uceNse� <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> L'OrF�'E S i r1N0/O.t F/�r � <br /> S�itc'[= �Eledric _Gas_Other 3� —� <br /> WORK DESCRIPTION 0 r�. F}���/�/(s, /{/F [t�lc L ��Q �j��Q Td �CL�/NkCL�/wtG{- <br /> t�i��E35U lHfi�///i"F R�SG /Jr.�T /N 5/�/k 9- i�Gc�� O�/w� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITE�I NO. TYPE OF FI%TURE OR ITEM <br /> Toilel A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash I�asin) Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer � Cbthes dryer <br /> W ak�r hoater Range hood <br /> � Sink(service/badmop/etc.) Exhausl ian <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinkinp Founlain Boiler <br /> Floor drain Refriperatan <br /> Grease Irap Woodstove <br /> Roof drains Olher <br /> � Other <br /> � — — <br /> I.! <br /> �' CITY OF EVERETT LOCAL SALES TA7(CODE IS 7105 � <br /> � I hereby ceritify that I have read and examined Ihis application and k�ow the same to be true and cortect. All provisbns o(lawa and <br /> ordinaces governing this lypo of work Hill be complied wilh whether specNied herein or rat.The granling of a permN does not preaume <br /> to give authoriry to violate or cancel the pro�ision of any other slale or local law regulating construction or the performance of <br /> construction.Thal I am authorized by ihe owner of ihis property lo peAorm the woric for whfch applicatbn is made and I comply with lhe <br /> Slate Conlr ors Law 18.27 RCW and 296.200 WAC. <br /> � ' �'c.-� <br /> Si ure /wneq oNra r ulhorized Agent Date �' <br /> i 2 <br />