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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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM $ —�O � <br /> SITE ADDRE33 PARCEL TAX I.D.# �j pc� O / <br /> A,�s r�u� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC.� <br /> ONMER� C A �� ADDRESS CITY2IP PHONE <br /> K•trff Y�/ N 2�� - 4 3e -04�� <br /> M�`rsa TQ� rnAVNc cZo2o5 pc��c�rs �� £�.wx;F 9�3Zo/ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �/�L+ I7��19�-a,I�l E-MAIL <br /> Z�T�` PSLCNvGIc Cw�Q.lctoe.S Po ;�u?y <br /> �_����,�o w� <br /> CONTR.LICENSE M �S����b��� <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other �2�j, O U <br /> WORK DESCRIPTION �t L�c A rroh/ O F �j-iA S N'�t rC-'fZ. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lava�ory(wash basin) � Gas pipfng <br /> Shower Water heater <br /> Kilchen sink B disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mopletc.) Exhaust fan <br /> BeckFlow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Founfain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certi(y lhat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing ihis type of work will be complied wilh whether specified herein or not.The granting of a pertnit dces not presume <br /> to give authority to violate:�r cancel the provision of any other slate or local law regulating construction or ihe performance of <br /> construclion. Tha! I am authorized by the owner oi lhis property to periortn the work for which application is made and I comply with the <br /> St�te Con tors Law�1 7 W and 298. 00 WAC. <br /> �v // �.�,� S`7�o - /O <br /> Signature of wneNContra or uthorized Agent Date <br />