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` _ <br /> P�RMIT 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 <br /> SITE ADDRESS P R EL TAX I.D. ��� PERMITII <br /> O D 34��0(OD/OD <br /> G' �1 �3 0 <br /> LEGA L T NO. BLOCK TRACT <br /> �ESC. <br /> OWN���ve � ��� / ADDRESS CRY21P PNONE �l <br /> CQ� v,5 y >,c�r= <br /> Y'u�`'�h �3ra�.�. �C-�� �n� ,DL - Y1��P-�:S-rLL.—L /,o. �l�F��'lD ,�l.��S7d�n <br /> TENANTNAME C�CTFOR RMIT PHONE <br /> 36d���$s�o <br /> N�1,1� ..,�A �7N.[�n..��,.�,C �f f�e�rJ�C.N�.v. 1�orlLs6o 9is3� <br /> CONTRACTOR A�DRESS CITY2IP PHONE <br /> CONTR.LICENSE N ��5��T 9��LL <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 1 �� �Eleclric _Gas_Olher <br /> WORK DESCRIPTION <br /> ,��v✓1 O ���-f d N � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(7URE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(servico/bar/mop/elc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby cerili(y that I have read and examined Ihis application and kncw the same to be true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whether specified herein or noL The granting of a pemit does not presume <br /> lo give aulhorily to vioiate or cancel the provision o(any other state or local law regulating construction or the perfortnance of <br /> conslruction. That I am authorized by the owner o(this property to perform the work tor which application is made and I comply with lhe <br /> Slate Conlr cl rs Law 1827 RCtW and 296.200 WAC. <br /> � ��"1� .r-K . �o/rs/o� <br /> ��. <br /> Sign re f OwnedContract dAuthorized gent Dale <br /> / <br />