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NERMIT APPLICAT�t)N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 4�1 S'O� <br /> SITE ADORESS PARCEL TAX I.D.A RM • <br /> 18 Y �, Q�� do 3 lgea I o o�? •o i� <br /> LEGA LOT O. BLOCK TRACT OR SUBDMSION It c� �� <br /> DESC. ��8 N H ��, -� �� �. � <br /> OWNER\ � ADDRESS CITl21P HONE H�S_1�.1 q�/ ,� <br /> RIG �a✓ L] k � l IvaP� 19 � 8 f2 �r �Cc�v GUFYP�"98Ao1 ,� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> . nr� � s k rr,�¢` y� 7 _ 3 z>-g��,� <br /> E�NINL <br /> �a�r�ai p�o �l � /2� y <br /> CONiR.UCENSE N �/� <br /> USE OF BUILDING HEAT SOURCE C�l I CONTRACT PRICE OF WORK <br /> / �. .,p <br /> R��-j �N� _Electric ✓Gas_Other G`�jl r q������ <br /> • <br /> WORK DESC�OV'<NGtvU�+� �� r �� �_--- <br /> F �'"� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FI%TURE OR ITEM <br /> Toiiel AIC—afr handling units <br /> Balhtub Forccd eir systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler heater <br /> _ Kitchen sink 8 disposal _ Gas fireplace N/a <br /> Dishwasher r Gas range <br /> _ Clothes washer � h _ Cbthen dryer <br /> Water heater /� _ Range hood <br /> Sink(service/bar/mop/etc.) Exhaust han <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralfon <br /> Grease Irap Woodstove <br /> Roof drains Other <br /> O�her _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> i hereby ceritify lhat I have read and examined this application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces govemirg ihis type of work wil�be complied with whether specified herein or not.The granting of a pertnil does nol presume <br /> to give authority to violate or cancel lhe provision of any olher state or loca�law regulating conshudion or the per(ortnance of <br /> constr ' n.That I am authorized by th wner his property to perform the work for which application is made and I comply with the <br /> Sta Conlr clor a 18.2 W and 96. AC. <br /> l � ^ <br /> 1 �� <br /> Sign Wre o 0 nedConiracW�A th nzed Agent Dat � <br /> �2 <br />