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i <br /> PFRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � — ��—D� <br /> SIT�HDDRESS (�}�O M�rr��1 C�ck PARCELTAXI.D.iR PE///R���MIT/ �/ <br /> parkwc..+, [-v¢iG��- � W{� ti8au3 / 7� �_" � <br /> /� <br /> LEGAL LOTNO. BLOCK TRACT 1� � <br /> DESC. La� � .�`.Je.n.�Ja� �faLT 1 <br /> OWNER ADDRESS CITY2IP PHONE <br /> �.,�e�r�-ed 1�c1�1�„�s 2nc L�C <br /> TENANT NAME CONTACT FOR PERMIi PHONE <br /> ln�,-���a� T���,�o������, src. I S��h�,. ��,�d�,���,,. �4aS-a�i3 -034-1� <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE X <br /> USE OF BUIL�ING T�g�,�, Qr�` I HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> m���`������r��`J _Electric V Gas_Other ���� — <br /> WORK DESCRIPTION1- 1� l� � <br /> ivlS�a`1 UVQ�^YIQA� Y1o1S� lY� `M4+�N'S"c\C�JYIhG� LIYCA. ' \n/ \ <br /> J <br /> C' <br /> �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal Gas freplace <br /> _ uishwasher Gasrange <br /> _ Glothes washer Clothes dryer <br /> _ Laund�y tray Range hood <br /> Sink(service/barlmopletc.) Exhaust fan <br /> _ BackAow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease lrap Woodslove <br /> _ Roofdrains � Other O�f��tu�� �1015� <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby centi(y that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing ihis type o(work will be complied with whether specified herein or noL The grantina of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any other state or local law regulating construdior or the pertormance o( <br /> construdion. That I am authorized by lhe owner of this propeity to perform the work for which application is made and I comply with the <br /> State Contr,ctors Law 1827 RCW and 296200 WAC. <br /> �%:.�_� >M I .���/O� <br /> Sgn re Owner/ tractodAut orized Agent 'pateT— <br />