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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—wuvw.everettwa.org <br /> APPLIGATIONS ARE ACCEPTED FROM e AM TO 4 PM � Z — � I/lJ <br /> 317E ADDRESS PARCEL TAX I.D.11 ��T R <br /> 093K f.� � � �elc�- C.0 — <br /> LEGA LOT NO. BIOCK TRACT OR SUBDM510N A <br /> DESC. <br /> OWNER ADURESS CITYIZIP PHONE <br /> TENANTNAME I CONTACTFORPERMIT P��E �j(,6'C�S3 '7ZZ� <br /> ���� (( , h s EJAAIL N�PL P�lN� ��.�^ <br /> �„�oL'T-t we_.SZ l��c,ms� n5 �n-� 3gIU ��6y1� PI 1J� a4vl�n5Yon. �'� �g223 <br /> CONTR.UCENSE A �S��_ � 1�9 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I Electric ✓Gas_Other � 3 ���' �' <br /> ��'IUC,�� ���il�G✓�LC� — <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A�C—air handling units <br /> Balhtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas firepiace <br /> Dishwasher _ Gas range <br /> Ciothes washer _ Cbthes dryer <br /> Waler healer _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan i� <br /> BackFlow preventer _ Heatpump . <br /> Urinal __ Unit heater , <br /> Drinking Fountain _ Boiler � ��, �� <br /> Floordrain _ Refrigeration I <br /> Grease trap _ Woodstove �� �,4 C��� <br /> Roof drains _ Other � <br /> Other = �� � <br /> — I <br /> CITY OF EVERETT LOCAL SALES TAX CODE 19 J706 <br /> I hereby certity thal I have read and ezamined Ihis application and k�ow the same to be true and cortect. All provisions of laws end <br /> ordinances governing this type of work�vill be complied with whelher specified herein or not. The granling of a pertnit dces not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating wnstruction or Ihe performance o( <br /> construction. That I am authorized by the owner o(this property to perform the work for which applicalion is made and I comply with the <br /> State Contradors Law 1827 RCW and 296200 WAC. <br /> ��L�i < � //l�� S l � � ZZ —l � <br /> Signature o Owner/Contractor/Aulhorized Agent Date <br /> 1/ <br /> Z <br />