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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-vwuw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.M PERMIT 1� <br /> �.n/z-r-i' r+vr Ml (o <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION M <br /> DESC. <br /> OYVNER ADDRESS CITY2IP PHONE <br /> 1011 HEwTrr �v� �vEeerr tizs- zs9- �� <br /> TENANT NAME CONTACT FOR PERMIT �HONE �3-4oS-7845 <br /> 'S NA assan 5 te� ftBSI Ge ��c`R- E�IMIL <br /> �ZtCNuGC Cd�rRA�toR� �o [j�yc2T79 K� 25S-V06'-7E9S <br /> CONTR.LICENSE M 7TLGNC= IIX tn�► <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas_Other ���� n� <br /> WORK DESCRIPTION <br /> GAS 1=�•-•a-( C.SNL �KrwTIO� C �l'LOC.I �FON DFGtAS l�'�t TC�L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handling unils <br /> — Forced air systems <br /> _ Bathtub T Gas piping <br /> _ Lavalory(wash basin) — Water heater <br /> _ Shower — Gas fireplace <br /> _ Kitchen sink&disposal — Gas range <br /> _ Dishwasher — Clolhes dryer <br /> _ Clothes washer — Range hoad <br /> _ Water heater Exhaust fen <br /> _ Sink(service/bar/mop/elc.) —' Heat pump <br /> _ Backflow preventer — Unil heater <br /> _ Urinal Boiler <br /> _ Drinking Fountain — Refigeralion <br /> _ Floor drain — W�g�pVe <br /> _ Greaselrap — Other <br /> Roof drains — <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7106 <br /> I hereby certify that I have read and examined this application and know lhe same to be true end cortect. All provisiom of laws end <br /> ordinances governing this type of work will be complied with whether specified herein or not.The grandng of a permit doea not prosume <br /> to give authority to vidate or cancel Ihe provision of eny other state or locel law regulating constructfo�or the perfortnance oi <br /> construction.Thal I am authorized by the owner of lhis property lo perform the work for which epplkatfon fs mede end I compry with the <br /> Stale Co tors Law 18.27 RCW and 296200 WAC. G <br /> �t/�� � � �"�b ��0 <br /> Signature o�.f7wnedContreclo�r¢ed Agent Date <br />