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• ' 9 `. <br /> 1 <br /> PERMIT /�PPLICATION <br /> CITY OF EVERE'�T PERMIT SERVICES <br /> 3200 CEDAR STRtET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AJDRESS PARCEL TAX I.D.# PERMR# <br /> �',� 1� r'�"tG;-- '•rli% ',,:- ;;; ��.-��:� -r- :;��x�� � C.O$61- C71Co <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION• <br /> DESC. %'.�'i� .7? �.^i- ';'•::-, ✓�/t.'�:�� /f� VL�! <br /> -�-: i �. , <br /> OWNER ADDRESS CITY2IP PHONE <br /> �L r ) r w' /'� i ,�u ♦.-�� �' �� <br /> � .. �;`� �'''i,%�!L- - � �:i' �"f'c^ .�.,��� t1✓l-•--SLr_- , L}./nr; ��..^!Ji_ <br /> TENANT NAME CONTACT FOR PERMR PHONE 7`t�,- /�•r. i ��`� <br /> �i,._ '-�..� �'ti7.���V�i - � .. . �/= <br /> I.'_i <br /> lV,'� 1�'� '' �:=:^` E�.IAIL <br /> �— <br /> /';�;`j4�!_ . <br /> CONTH.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'."f,; _ Eleclric ,,,�Gas_Other 'f�7,/'"' � <br /> WORK DESCRIPTION ' /7`' '^/ �-y, <br /> _t�7;� .'y' .. . �. :,/•-. -!-:•>-r,.i..,�,'/�l,� /'., r�r !� " /ff�/lY� y✓ .��! l <br /> `r ` . ,� �:� y1��' �.� �-- � : -- '-�:c ,�i�t;Uy <br /> ,_ �- , <br /> ; _ �:. , _ <br /> PLUMBING MECHANICAL <br /> �IO. TYPE OF FlXTUFiE OR ITEM NO. TYPE OF FI7(TURE OR ITEM <br /> Toilet A/C-air handlinc�units <br /> Bathtub Forced air systems <br /> _ Lavatory�wash basin) „� Gas piping <br /> Shower � Watcrheater <br /> Kitchen sink 8 disposal _ Gas lireplace <br /> � Dishwashcr Gas rxnc�o <br /> `�._ Clothes washor � Clolhes dryer <br /> � Waler heater � Range hood <br /> . Sink(sorvice/bar/mop/etc.) Ezhaust lan <br /> Backflow preventer Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain boiler <br /> Floor drain Refrigeration <br /> Greasa trap Woodstovc <br /> Root drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 9105 <br /> I hereby ceritity that I have read and ozamined this application and know the same to be true and correct. All pmvisions of laws and <br /> ordinaces goveming Ihis rype of work will be complied with whether specified herein or not.The granting ot a permit does not presume <br /> to givo authonty to violate or cancet tho provision of any other state or Iocal law regulating construction or the peAortnance of <br /> consiruction.Thnt I am authorized by the owner of this property to peAorm 1he vrork lor which application is made and I comply wilh the <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> ,`���`1 Y�iI�S���9/1 !-2Z � <br /> Signjaytu�re of OwnedContractodAulhorized A ent Date <br /> � �Z�i'l ( ���L+�/�/_�/������� ��Z <br />