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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-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ���'�/ <br /> SITE ADDFESS PARCEL TAX I.D.M pERM1T Jf <br /> �5'T YN�R! ' l. � �0 Z '� �l <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVI510N Y � <br /> DESC. <br /> OWNER ADDRESS CITY2IP PH NE <br /> ����- �=� 1 �' —►��-- c�r R�za <br /> TENANT NAME CONTACT FOR PERMIT PIiON �i 2S2—�T�— <br /> ��t/�G ""1NGlMT76c'r T�C�/� I ���� �'4'L-U E•MAILKQ✓15r:.IrfDDSS.'Hl.�ct. 4ft <br /> ZT R ADD�E�` IT /21P P E <br /> C=�e,z6u�-�S�i�rr� 1-�.-� € ,�C ZiZo Y�ru��c ��r- �szor wzr) zs2-3J�Y <br /> CONTR.UCENSE N <br /> l=a/N(L�'j SC n7�n'f— <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C _Eleclric �Gas_Other ��('�C7 <br /> WORK DESC IPTION <br /> 2�.<.iv �ts 4►i.�- t� l�n�s�.-�� `T'�r <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TVPE OF FI%TURE OR ITEM <br /> __ Toilet A/C—air handling un!ts <br /> _ BalMub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Showor Waler heater <br /> __ Kitchon sink 8 disposal Gas liroplace <br /> Dishwashor Gas range <br /> Clolhes washer Cbthes dryar <br /> _,_ Water heater Rangc hood <br /> Sink(service/bar/mop/elc.) Exhaust lan <br /> Backflow proveNei Heal pump <br /> Urinal Unit hea�er <br /> _ Drinking Foun�ain Boiler <br /> Floor drain Rofrigeration <br /> _ Grcaso trap Woodstove <br /> Root drains Othor <br /> Other <br /> CITY OF EVEflETT LOCAL SALES TAX CODE IS 3705 <br /> I here6y ceritify ihal I have read and examined this application and know the samo to be true and correct � �i provisions of laws and <br /> ordinaces governing this type ol work will bo complied with whelher specified herein or noL The granting o� a �ermit does not presumt <br /> to give aulhority to vio!ato or cancel tho provision ol any other state or la:a��aw regulatiny construction or ihe p �Aormanco of <br /> construaion.Thal I am authorized by Iho owner ol this property to perform ihe work for which application is mao: and I comply with ihe <br /> Statc C ntr ctors Law 1 27 W and 200 WAC. <br /> _ , �,� 2 - y - Zo�� <br /> Signat re of wned ontractor/AuTracd Agenl ate <br />