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P�RMIT APPLICATIt,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 6 �a �/D <br /> SITE ADDRESS PARCEL 7AX I.D.A PERMIT II <br /> 0�9 P�.,�� A� ���-�� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDM910N� <br /> DESC. <br /> OWNER ADDRE9$ CITY2IP PHONE <br /> f u���i� �un�� �r���1 �� � /o Il � ,�� �� <br /> TENANT NA C MTACT FOR PEFMIT 3(lJP1qHE �( ' S� <br /> �� � �/�1�/L E�NIMLE�CY! HfG(/ <br /> (:o-���a 6y7 � Su� .,� Or' /1�..�,r°, co.n <br /> CONTR.LICENSER �J�Q.� T �it��p 77/�/s l' /rQ� /�l/OwA /_ )� 9 G�7a.�J 32� / <br /> rt 'J .�P�I/ 6 --/ l^� d f 7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 1'�� _Electric X Gas_Other �',G� <br /> WORK DESCRIPTION `�n�Q���.o�An� �� J/j� / �v � � /{t/f` <br /> � ��s �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FOCTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> � Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink 6 dispoRal Gas fireplace <br /> � Dishwasher Gas range <br /> Ciolhes washer lolhes dryer <br /> � Water heater _ nge hood <br /> _� Sink(servicelbarlmop/elc.) Ex usl fan <br /> _� OackFlow preventer � Heat ump <br /> _� Urinal _ Unit heater <br /> _1 Drinking Fountain _ Boiler <br /> � Floor drain _ Refrigeration <br /> �— Grease trap _ Woodstove <br /> � Rooi drairys�! � ��! _ Other <br /> Other rr�--�—+*++�o <br /> — --- I <br /> CITV OF EVERETT IOCAL 9ALES TAX CODE IS J106 <br /> I hereby certify that I have read and examined this application and know the same lo be true and corred. All provisiona of laws and <br /> ordinances governing this type o(work will be compiied with whether specified herein or nol.The granting of e pertnit does nol presume <br /> to give authorily to violate or cancel the provision of any other state or lacal law reguiating wnstruction or the perfortnance o( <br /> construction. Thal I am authorized by th ner oi ihis property to periorm the work tor which application is made and I comply wRh the <br /> Sfate Contract��w 10. CW a�20f�OJAC. <br /> l j'� 6 -��� <br /> Signa�e wnedC nira odAuthonzed Agent Da) � <br /> �P <br />