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i t <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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AAA TO 4 PAA <br /> SITE ADDRESS PARCEL TAX I.D./ PERMIT X <br /> � <br /> . I�� �� i—i�.n:. `�T. �V^ -- i �-Jra �� � J(,l <br /> LEGA LOTNO. BLOCK TAACTOASUBdVSWN• <br /> DESC. <br /> OWNER ADDRESS CfTY(AP P110NE 3��� ,� <br /> �C�Y�r� ����r,��5<',.� 1 �1�I1�.� � i�•t RYe (,�J�o- G�wr�,�oo `� �J''�i ��°f -Gx�ti(�� <br /> TENANT NAME -COHUCT FOR PEFMAR ' PHONE='(y.=, �J4 - (:1:���1(,, <br /> I ' �.)C�VI'_l `��fiVi�i'� E�INL <br /> ��CIi1 �i �Zvn.•.:�. h� R,�C.,l �/�.a�J <br /> corrtn.uCeruE,� ����•_ . �i�,� ��1j /� <br /> USE OF BUILDING HEAT SOURCE I CONTAACT PRICE OF WORK <br /> ��,Z��n c,!-�1 ��n`-, i .j� ^�c�. _Eleciric _Gas_Other <br /> WORK DESCRIPTION <br /> (�1��f�:r.'�� f)�J inJ;.� � iJ.1 � <br /> rV•J `>�17 vc_l'���2. q'� � tv� �. �' i . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlICTURE OR fTEM NO. 7YPE OF FlXTURE OR RL•M <br /> � Toilet AIC—air haodlirg units <br /> � Bathtub Forced air systems <br /> i Lavatory(wash basin) Gas piping <br /> Shower � Water heater <br /> Kitchen sink&disposal Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer � Clothes dryer <br /> Water heater I Range haod <br /> Sink(service/bar/mop/elc.) Exhausl fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> Floor drain � Refrigeration <br /> Grease trap � Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceri�ity that I have read and examined lhis application and kraw the same to be true and correct. All provisbns ot laws and <br /> ordinaces governing Ihis lype o(work will he complied wilh whether specified herein or not.�he gran6ng of a permit does rwl presume <br /> to give authority to violate or cancel Ihe provision of any other state or local law regulating cons[ruclion or the pertormance of <br /> construction.That I am authorized by lhe owner o1 lhis propeAy lo perform the work lar which application is made and I comply wilh the <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> , � � ' � "� <br /> -- ��_� � � _ <br /> SignaWre o er/ on rador/Authonzed Agent Date <br />