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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 2� a� �-O7 <br /> SITE ADDRESS ` I PARCEL TAX I.D.A <br /> L 2U �W �T�C -��1� . t PERMIT t <br /> �.�lor�I�I'UO l D O ,.. -�-�'�, a <br /> LE LOT NO. }LOCK TRAC�T•I <br /> DESC. I ��i' b. D� �J7'+�W��IiC7 <br /> OWNER ADDRESS CITY21p PHONE <br /> �tL� WNb LI,G• ���i 2`��" �,,1�•� • �t/�i"l l�i;� `i�,10 ' <br /> � - b 2�Y,'�`i•4��j'� <br /> TENANT NAME CONTACT FOR PERMIT <br /> PHONE <br /> �;�(r �ur..�� ���. �Nr '�� � (�P� ►�� - 2t;2 • 2��� <br /> CONTqACTOR <br /> ADDRESS CRY21p PHONE <br /> ��`'J�7 \ �T <br /> CONTR.LICENSE i � �(j��,;�J ,� ZOG� ��J 9 �S-�� <br /> - �._�_ Gl ; ��13I� �5 �� <br /> USE OF BUILDING HEAT SOURCE C� NTRACT PRICE OF NfORK <br /> x E�ectric _Gas�Other � r/��O�, O(� <br /> WORK DESCRIPTION <br /> C�i�o. �f��T. lat:o�Nt� �= w,-�F; .� cv��..�;v�t r.��N �„�o� y� F <br /> R:�-���+�r�-��a T, <br /> PLUMBINC MECHANICAL <br /> N�• TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> � Bathtub _ aC-air handling units <br /> � Levatory(wash basin) — F�d air systems <br /> Shower — �s WW�9 <br /> � KNchen sink 8 disposal _ Water heater <br /> � Dishwasher _ Gas firoplace <br /> Clothes washer _ Gas range <br /> Laundry tray _ Clothes dryer <br /> �, Sink(service/bar/mop/etc.) ._ Ranpe hood <br /> Backflow preventer _ �haustfan <br /> Urinal _ Heat pump <br /> Drinking Fountain _ Unk heater <br /> � Floor drain _ Bofler <br /> ,� Grease trap ._ Refrigeration <br /> Rooi drains _ W�dstove <br /> — ane� — an�� <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS�105 <br /> I hereby ceritify that I have read and ezamined this applicalion and know lhe same to be hue and correct. All provisions of lews and <br /> ordinaces goveming this type of work will be complied with whether specified h¢rein or not.The granUng of a pertnit dces not presume <br /> to give authority to violate or wncel the provision of any other state or local law regulating construdion or the peAormance of <br /> construction.That I am authorized by Ihe owner of this property to perform the work tor which application is made and I comply with the <br /> Contraqors L w 18.27 CW and 2 6.200 WAC. <br /> �' 7 ��,- O� <br /> Si atu of OwnerlContracto Authorized Agent Dale <br /> i�� ; <br />