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� —. <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —vuww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM ti pM TO 4 PM (� .- a o -0 7 <br /> SITE ADDRESS PARCEL TAX I.D.q P6RMIT tf <br /> 23� M 78 O OD GY� � ?C' �- � `�� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. SE� AC�C� <br /> OWNER ADDRESS CITY2IP PHONE <br /> s u,G l 11� � � � �N Z <br /> TENANT NAME CONTACT FOR PERMIT PHON 20� �5. ZXjCj� <br /> 1-Ai�NAL 1-NVL �-i�-Cl EMAIL P�'^^-nlS ��' <br /> CONTRACTOR AD�Fl SS CITYIZIP P ONE <br /> �f$P <br /> CONTR.LICENSE# <br /> USE OF BUILDING s � — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �!i �E ��"'` 1.� Eleciric �as_Othcr � �j� (�QV <br /> i <br /> WORK DESCRIPTION � �'��� '�r � 7� ��� ��S � DOhIS� <br /> � <br /> =.�a4c� F(�z., o�G. U9a �N11�. �►� IV�IN 4c1��}'L W� <br /> J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OFl ITEM <br /> Toilel A/C-air handling units <br /> Bathtub _ Forced air syslems <br /> Lavalory(wash basin) ___ Gas piping <br /> Shower Wa�er heater <br /> Kitchen sink&disposal _ Gas lireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer Clothes dryer <br /> Waler hea�er Range hood <br /> Sink(service/bar/moplelc.) _ Exhaust fan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floordrai� _ Refrigeration <br /> Grease trap _ Wondstove <br /> Roof drains Other <br /> = Olhe� _ � — ���T <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilily ihat 1 have read and examined ihis applicalion and know ihe same to be irue and correct. All provisions of laws and <br /> ordinaces governing ihis lype of work will be complied wilh whether speci�ied herein or not.The granting of a permit does not presume <br /> lo give aulhorily to violate or cancel the arovision of any other state or local law regulaling construclion or the performance of <br /> cons�ruclion. That I am authorized by the owner of this property to perform�he work lor which applicalinn is made and I comply wilh lhe <br /> Sla�e C�ntr �L v 18.2 RC and 296.200 WAC. <br /> ��7�•oT <br /> Signature (OwnedContraclor/Aulhorized Agent Date <br /> `l v <br />