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f <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.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRGM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT it <br /> "I i \Icrrill Crcck '_811�11?IIIIt1 11 1 31 11 1 <br /> ��� . )� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. 19ca.c .rc tilu�cl.\-I �dll�c curl��.i�d pl;nu. <br /> OWNER ADDRESS CITY2IP PHONE <br /> P�d„Pi�qNiuc. I.L(' !1'r{0!Il)Icmpir\'i�a Ih 1'.dm��ud.\\':\!180`)11 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Kr�1C�nn :\ssuc - �cnnilcr'I:�cl�ic -}��-27-I-�7-1-1-1 cst. 1-I I <br /> \'1'�\I \I�d,ilin I•I-13? til? 1?a.ie:uc \C'a�� tiuitc 'GII Rcllc�•uc. \C':\ 9};nui <br /> CONTRACTOR ���i;i� ADORESS CITY2IP PHONE <br /> CONTR.LICENSE it <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I�/:\ <br /> Com�ncrcial/rctail Electric Gas Other $I�,IIIIII.IIII <br /> WORK DESCRIPTION <br /> Rcplace/up�radc antcnnas at cxisiinG�circicss lacilin�. Plcasc scc cncluscd 1'rojcct Dcscripti�m tbr murc <br /> dctailcd intircroatiun. <br /> PLUMBING MECHANICAL <br /> ND. TYPE OF FI%TURE OR ITEM N0. 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 fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmop/etc.) Exhausl fan <br /> BackBow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> RooF drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SAIES TA%CODE IS 3705 <br /> I hereby ceritity that I have read and examined this application and know the same to be true and correc4 All provisions of 12�^s and <br /> ordinaces goveminy this type of work wdl be complietl with whether specified herein or noL The granting of a permit does nol,..esume <br /> to give authoriry to violale or cancel the provision of any other state or local law regulaling cons�rucGon or lhe performance of <br /> consiruction. That I am authorized by the owner of this property to perform the�vork for which application is made and I comply with the <br /> State tractors Law 1 37 CR W anD 296 200 WAC. <br /> I <br /> , ,,� � l ,� ,� lUl `JIG-, <br /> Sig� �ot OwneuCon ctodAuthp Agent Date �/ <br /> , <br /> \ � � <br />