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1 ( j <br /> i <br /> -- . I <br /> PERMIT APPLICATION � <br /> ; <br /> CITY OF EVERETT PERM!T SERVICES �� : <br /> 3200 CEDAR STRF,ET, EVERETI', UJA 98201 /'i � <br /> 425-257-8810—FAX 425-257-8857—www.everellwa.org I��i� 1 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT&CREDIT CARDS ARE NOl'ACCEPTED <br /> I <br /> SITO ADDRE55 �T I PAR EL TAX I.D.# PERh11T# ' <br /> /4fl! MFRRIGL CFEE/� tA1�'i► C�v �p [�� (r�D I �/ � <br /> LEGA LOiNO. BLOCK TRAC7� �v�O �� ��ZQQ I <br /> DESG � I � � <br /> OWNFR qDDRESS CINILP PHONE � <br /> FF�af�fs�7"�.�. s5�ro MoP�bc��. sr�r7�2ev�s�wirEro U. 9yis.i j <br /> 1�[NANiNAME CCNTACTFORPERMIT � PHONE i <br /> f=F ��,��-�.P._ I � ��/���,� �.���� Z/z3 � <br /> ; <br /> CONTRACTOR ADDRESS CITYi7P PHONE I <br /> CON7R.LICENSB R � <br /> � USB OF BUILDIN'l NEAT SOURCE CONTRACT PRICE OF WORK � <br /> �,�TME��;�//�/�'�'.—f I �Electric _cas�other I�'1Oj OGU'��tl0.BO � � <br /> WORKDESCRIPiION ��^r ����,�,N6S � <br /> /B-3 STa•e.Yh�7" , i <br /> � � �,�.�.� - <br /> � <br /> YLUMBING MECHANICAL i <br /> � <br /> NO. 7YPE OF FIXTURE OR ITEM11 NO, TYFE OF FIXTURE OR ITEN <br /> � <br /> Toiiot • NC—air handling units � <br /> Bathlub• Forced air systems t <br /> Lavatory(wash basin) • Gas pping � <br /> Showzr � Weterhealer• i <br /> ��O Kitchen sink&disposal • ,���� Gas fireplace /" <br /> Dish�vasher• � Gas rance � <br /> 2Q(� Cloliies washer• � Clothes dryer• <br /> Laundry Uay Rafge haod • <br /> _ Sink(servicelbarlmop'ela) rf� Exhaust fan• I <br /> _ Dackflowpreventer Heatpump I <br /> _ Urinal � �� Unit hea � <br /> _ Drinki�cj Fourlain _ t3oiler � <br /> Floofdrein Ref� eration �� <br /> _ Greasc Imp ._ �odslove � <br /> ,Roof dreins � thcr <br /> _r Othor _ — <br /> — i_ <br /> i <br /> . CITY OF EYERETT LOCAL SpLES TAX COD'e IS'J106 � <br /> I hereby coritify that I have read and cxamined Ihis appl'�cation r��J 1�•�w Ihe same to he We and tarrect. All provisions of lows and <br /> ordinaces govemirg this type ol work will Eo complied Hvlh vih,ether spedfied herein or not.Ttie granting ot a permil does nol presume <br /> to give aulhority to violale or cancel Iho provision o(nny oth�r state or local fow regula;ing cronsWdion or lhe perfortnance ol <br /> wnslru t�nm outhorized by lhe owner of this pwparry to pedorm the�vork for which applicalion is made and I comply wlth the <br /> Slal ontraclo Ln �°°�a 296100 WAC. <br /> ����LL�. 5-//-ah� <br /> Signa�ro� onl�L` ractod�ut�iorizedAgent ate <br /> f�Ii°�-M_/�A�+�1 s, M�F <br />