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i <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.evereriwa.org /� �7`�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L° �D/ol -D�� <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT N <br /> s - . /1'I�G%c� s� . ��oid , ooa- <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> ONMER ADDRESS CITY21 HONE <br /> ��tn�0;�n�G�✓ zA�e��;�v ���� _ �,, ,,�� G;�c s�. �,� tizs--3y6- �r� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> n�o vE.VT� �<I-n.o;9.✓� 232oy- !4'�A,' y2 s- 2 3 2 _a6 � <br /> CONTR.LICENSEk � /�/� f' f n°'v"yz.,r- y7� - �3! <br /> 5oN ar oi� ��I�U�f •Y�0 2 ( <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> s �, � I _Electric lLGas_Other Z$� ��,Pu <br /> WORK DESCRIPT�ON <br /> j\�'/J�ace � %��SSPS fr-�.S 6'�ate /�iVs3 ��Irr+ �lGe.o /.�r F�i'e <br /> �$V K��'j'lG3t� ?Vr/�QC� ���iri3./a� �n�n/�y� ) �/Pc77iiU�(� �i/1� 99iK�.Q r�CX�l . <br /> J / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> _ Bathtub � Forced air systems �f-v��uc t on/y> , <br /> Levalory(wash basin) � Gas piping <br /> Shower � Water heater <br /> Kitchen sink 8 disposai _, Gas fireplace <br /> Dishwasher Ges range <br /> � Ctothes washer = Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) Ezhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Reirigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and ezamined this application and know Ihe same to be Irue and corrcct. All provisions of laws and <br /> ordinances governing ihis type ol work wil�be complied with whether specified herein or not.The granting of a pertnit dces not presume <br /> to give authoriry lo vioiate or cancel the provision of any other state or Iocai law regulating consUuction or the performance ot <br /> conslruction.That I Am au�liorized by the owner of this property to pertorm lhe work for which application is made and I comply with the <br /> State ConlractoFg L.���.27 RCW and 296200 WAC. <br /> %G �� �� � %�C <br /> SignaWre ot OwneNCont ctodAuthorized Agent � Date 3� <br /> 1 <br />