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PERMIT 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 Z �- I—O� <br /> SITE ADDRESS PARCEL TAX I.D.A PER ITA <br /> � �w `fd-- �5�t b� �a o 0 • 03S <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION K <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �;�lv�,'� l�L L <br /> TENANT NAME CO� N/TACT FOR PERMIT PHONE �0(�,G�r3-/y�y <br /> �G1r✓�� G��G� �� 4Gr��G'L � L'1TP/3 EilAl7R�6qvut7N?Co.� •wt�l <br /> � .�7vK �o�s• Lcw«�G.r �J�.. yafi�i/�lsr�3�7 ��6 -3a-4 -Fs�� <br /> CONiFi.LICENSE M /` �� �J / L G l y > (�� <br /> L i/ J j�.V <br /> USE OF BUILDiNG HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 7 G�(LVY� _Electric �Gas_Other .� �3��� <br /> �<:../ <br /> WORK DESCRIPTION <br /> ��� b�u � ' 7Y1�` 1 H��c(; o��- Cu�w.�.�r %�� a�-,e ��� � <br /> �4 �Vr G� �CEiui/ls�l�� �L� ���✓�- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handli�+g units � <br /> Balhtub � Fnrced air syslems \ <br /> Lavatory(wash basin) _ Gas piping \ ` <br /> Shower _ Walerheater O' f!1� <br /> — Gas fire lace /�� d`1V� <br /> Kitchen sink 8 disposal _ P /- / .,� <br /> Dishwasher _ Gas range �\ � <br /> Clolhes washer Clolhes dryer � � <br /> Water healer � Range hood � <br /> Sink(service/bar/mop/etc.) � Exhaust tan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined Ihis applicalion and know lhe same to be true and cortect. All provisions of laws and <br /> ordinaces goveming Ihis type ol work will be compiied with whether specifiod herain or not.The granling ot a permit does not presume <br /> to give authority to violate or cancel the provision o(any olher state or local law regulating construction or lhe peAortnance of <br /> construction.Tha I am.authorized �y1he owner of this property lo pedorm Ihe work for which applicalion is made and I comply with ihe <br /> Slale Con�c rs Caw 182 . and 29f.200 WAC. <br /> �- -� %/�,�� � <br /> �. �- <br /> SiqnaWfEe of OwnedConlractor/Aulhorized Agent Date <br /> ��� <br />