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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—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SRE ADDRESS PARCEL TAX I.D.A PERMIT� <br /> 3 a,E�.� a`� . ra o� ��c��z�oo ���,�,3 �,�., <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHOWE <br /> CHk�LEs TNan7P5o� �-�l3! PJ�NA✓rE"i�v BcvD. E��� �lzr-353 fi�G j <br /> g��o3 <br /> TENANTNAME CO�TACTFORPERMIT PHONE <br /> ��lA�� �c��;-�= �1Z5-7�5-1o�/G��. <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> DPrY�-/�i�rE O�m.sCT d-Ni(r 1(o61t1 �3.� M�Q Ll� C[Y�nI�luloc�D ��5-�y5-��rGy. <br /> CONTIL UCENSE M T�rJN1r�7•:����C{�Y` !��/ <br /> !/ T <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I _Electric �Gas_Other � ���O�, G� <br /> WORK DESCRIPTION <br /> (.�}eE �X�sTln/Cr Gr4S �t�l�' /tK� W 17Z-1 <br /> N�w C�i-s �-r�� � <br /> F,UMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 7YPE OF FI%NRE OR ITEM <br /> Toilet AIC—air handiing units <br /> Bathtub � Forced air sysDems <br /> La�aMry(vrash basin) Gas piping <br /> Shower Watar heater <br /> ltitchen sink�disposal Gas firaplece <br /> Dishwa;her Ges ronpa <br /> Clothas washer Clothes dryer <br /> � Laundry tray Range hood <br /> Sink(serviceibar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Uni[heater <br /> Drinking Fountain Boiler <br /> Floor drain Rafigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCIIL SALES TA%CODE IS 3106 <br /> I fiereby ceritify that I have read and examined this applicaEon and know the same ro be true aM cortact All provisions of lavr3 end <br /> ordinaces goveming this ype of work wiil be complied with whether spedfied herein or not The gianting of a parmit does not presume <br /> to give authority to violale or cancel the provision of any other state or local law reguleting construction or the perfortnance of <br /> construction.That I am autlwrized owner of this property to pertorm ihe work for which appliwtion is made aM I wmply with the <br /> SFate C ctors Law 1 R an 2 . 00 WAC. <br /> � -� -U <br /> Signatu of OwnedContrectod t Date <br />