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� � <br /> PERMIT APPLICATION <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 982(�1 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESB PARCEL TAX I.D.p PERMIT ri ., <br /> z I 3Z � � -;r�A�� o��, 3�,� `I3 l o l n� ��-� n <br /> LEGA LOT NO. BLGCK TRACT OR SUBDIVISIQN p <br /> DESC. �� y ' <br /> OWNER AUDRESS CITV2IP PMONE <br /> �1 o yJ We11� � Z132 (,�anJ pve ���n4� 4z.S-535-°�3yZ <br /> TENANTNAME CO�N�TA(�CTFORPERMIT PHONE 4ZS_5o1_95SG <br /> �!T`T"1 l..J�v\ S e�e�a���w'��c���tich}-,�.n� <br /> C0�(�7q C7b� 1 AOD1RE, LCITVlZIP PM N �y��rlcj�1 ,� <br /> 1J�iV��S [�n57��(�' �,-, ��nC. �� W N�Sl .`'�'1 J}ii Gvcl��7 h.+l <br /> CONTR.LICENSE p 5�"�1.1 4 ZS-So l-q 55� <br /> �{�V� C�'L O��OIC <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> I _Electric _Gas_Other � � I� s y � <br /> � WORK DESCRIPTION <br /> I Y�h,l� n�..., J � �1� �l�� <br /> �Nv 57, ur. 5 <br /> PLUMBING MECHANICAL <br /> � NO. TYPE OF FIXNRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> i Toilet _ A'C—air handling uni�s <br /> Bathlub Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> � Kitchen sink 8 dispossl G� s fireplace <br /> � _ Dishwasher _ Gas range <br /> Glnlhes washer Clothes dryer <br /> W ater nealcr Range hood <br /> i Siok(serviceibarlmop�rta) Exhaus�fan <br /> '� Bockflow preventer _ Heat pump <br /> � _ Urinal _ Unii heater <br /> , Drinking Fount��� _ Doilcr <br /> 'I Floor drain _ Rcirigeralion <br /> i Grease trap Woodstove <br /> Rool drains Other <br /> Other <br /> CITV OF EVERE7T LOCAL SALES TA%CODE IS 3105 <br /> I I hereby ceritily Ihat I have read and ezamined this application and know ihe same to be Iruc and correct. All provisions ot laws and <br /> � ordinaces governing this type of work will be complied with whelher specified herein or noL The granting of a permit does�not presume <br /> to give auihority to violate or cancel Ihe provision ol sny oihr.r state or local law regulatiny consiruclion or the performance ol <br /> ; construction. That I am authorized by the owner of this property to pertorm the work lor which application is made and I comply with�he <br /> �, Sta�e C �ra o Law 1827 RCW and 29G2J0 WAC. <br /> � �i`�.� �'21 -��j - <br /> I S�gn r Ownm!ComraclodAuthonzed Agent Date <br /> I /L <br />