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�tRMIT APPLICATIUN <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 ��� (�l��� 0 0� <br /> SITE ADDRESS PARCEL TN(I.D.�I P,ERMIT M <br /> 7 �3 r a - a oa- <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS C 21P PHONE <br /> �j ya.�-�i-ya5� <br /> �� � .arnr �7N �./�.uSTivrTn.0 ZM'. 77�� 7TS Jn/ Al,l� YYIrY!` �S�/_�`L����,� � r4-4>.Sr �+ <br /> TENANT�� I CONTACT FOR PERMIT � PNON@ <br /> .� . <br /> � % ' . A �, �,,.` To%n,t,' `/02;5- ,�3�.���iy'. <br /> EC' p��C�fP��� ` �sT` ��7� ADORESS CITY2IP PHONE <br /> I�Y Ov /lCA , : , , y,a.s-a���-y�� <br /> CONiR.UCENSE M C � P • ' ,� <br /> i <br /> � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S• i � _Electric �Gas_Olher <br /> WORK SCRIPTION 2 , I� NG S//��L' FQ%'Y►i�lY r�s���.,�� <br /> �JJ � � <br /> �s �1�i <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> � Bathtub Z Forced air systems <br /> Lavatory(wash basin) _� Gas piping <br /> Shower � Waterheater <br /> Z Kitchen sink 8 disposal � Gas Greplace <br /> � Dishwasher _,[_ Gasrange <br /> � Clothes washer L Clothes dryer <br /> � Waten c�alor Range hood <br /> Sink(servicelbar/mop/elc.) � Exhaust fan <br /> 8ack0ow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Groase trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS�105 <br /> I hereby ceritify that I have read and examined this application and know lhe same to be true and wrrect. All provisions of laws and <br /> ordinaces 5overning this type of work will be complied with whether specified herein or not.The granling of a{iertnil does not presume <br /> to gi��e authorily to violale or cancel the provision of any olher state or Iocal law regulating conslruction or the peAortnance of <br /> construclion.Thal I am authorized by the owner ol this property to peAorm lhe work lor which applicaGon is made and I comply with the <br /> State Contract rs Law,B 7 RCW a 29 200 WAC. <br /> _ � � <br /> . <br /> igna ure of ed oNraclor/Authorized gent Date <br /> , ��2 <br />