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ERMIT APPLICATI�N <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 � .,3.��Q7 <br /> SITE ADDRESS PARCEL TAX I.D.11 P MIT M <br /> Zb� o�� �.v�- �a-�9 � e��-o� gao � n�n5-�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. �G`�� �� � �^OO <br /> OWNER ADDRESS CITY2IP PHONE <br /> u oNs u.Ko o� �/�'rr , 38�2 p�zcv�wkY�4Vb.,�1t��EtT,482o I <br /> TENANT NAME CONTACT FOR PERMI� Y e�LL�y,l�,r�c PHONE <br /> U-brs-rx I ���`��-Fr�`r„ y�Z_�s3 <br /> CONTRACTOR /AD RESS CITYRIP PHONE <br /> CONTR.UCENSE N �--��/� / i �����{i�/�n L��J <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> i � <br /> �i�i�c U rZ�T _Eledric �Gas_Other �' �O <br /> � <br /> WORK DESCRIPTION <br /> `�."1�l�kl�" I M�1/�M�T4T �iz. �c '�-E�T1�C1/I�- <br /> I N �}U�sfl►J�Gt N�R-� ���f'r UaNS �-uA� . <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR(TEM <br /> Toilet A1C—air handiing units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Laundry trey _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backtlow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain ,_, Boiler <br /> Floor drain Re(rigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify thal I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher spedfied herein or not.The granting of a permit dces not presume <br /> to give authority to iolate or can I the p ision of any other state or local law regulating conslruction or the perfortnance of <br /> construdion.Th am authorize y t o ner of this property to peAortn the work for which applicalion is made and I comply with the <br /> State C tract s Law 18. 7 R 29 20 WAC. <br /> ��' .� , <br /> Sig re Owner/Contr or/ u h gen ale /Z <br />