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r L,I�i�qQ �`( O <br /> . ,_— . __ . . __ ___ _. __ _( --_ — —.� <br /> � <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.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �9 �- � —O9 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT p <br /> �a � ��o u sq a U�v�� ����q <br /> LEGAL LOTNO. BLO K TRACT <br /> o�s� . � -� uc �-4 S a �-oo � > a <br /> OWNER A�DRESS CITYIZIP PHONE <br /> C-�lev��� I��,o�ir.�C �nc� v� ��-�� <br /> TENANT NAME CONTACT FOR PERMIT P,40NF <br /> � (` �u�=l���. y as��l`��D <br /> CONTRACT �2 �W1"`\,v` ` ���S53 ��I��� �CITYIZIP �PHCEI � <br /> M �.v\ � <br /> TJ r� �- cy_v�� <br /> CONTR,IICENSE7f ������ ������ }�„ �j ` \ ��„�-( � , r.(lr G�OSa. <br /> C-��.��M. ��.VJ � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ������� _Electric �,Gas_Olher �'t��-� CQ I� <br /> WORK DESCRIPTION <br /> �v��.11 �.V�.cs� l��c.,���� �-��c�C-��. <br /> , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C-air handling uni� <br /> Oathlub � Forced air systems -�0.S �llrV�[�.2) <br /> Lavatory(wash basin) _`� Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas(ireplace <br /> Dish�vasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Laundry�ray Range hood <br /> _ Sink(servicelbar/mop/elc) Exhaust fan <br /> Dackllow preventer � Heat pump <br /> Unnal l init heater <br /> Drinking Founlain �;oiler <br /> Ploor drain �^fr�oeration <br /> Giease lrap Woodstu.c <br /> Rooidrains Other <br /> Other — — <br /> — — — � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceriti(y ihat I have read and examined this application and know the same to be true and correcl. /111 provisions of laws and <br /> ordinaces goveming this type of work will be complled with whether specilietl herein or not The granting ol a permit does not presume <br /> to give authority to violate or cancel the provision of ar/other slate or local law regu�a6ng conslruction or the performance o( <br /> construction. Tha�I am aulhonzed by the owner of ihis property to perform lhe work for which application is made and I comply with the <br /> State Contraclors 18 27 RCW and25)6200 WAC <br /> /�'C�� r%y oq i <br /> i Signature of Owner/Co�riraclorlAtlth nzed Agent Date <br /> I <br /> i <br />