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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 Id- a,g�-(U <br /> SITE ADDR SS PARCEL TAX I.D.N PERMIT N <br /> 7�� �. M/±RiN� ��w �K- !� �� - v� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION A <br /> DESC. <br /> ONMER ADDRESS CITY2IP PHONE 27 <br /> �uc Pt��r�.� 7� � E. I�►�2i ►v� u�rv� �� t-ut�-�- ti2� y�oo <br /> TENANT NAME I CONTACT FOR PERMIT PHONE�"L�Z 3��� dU <br /> E-MAIL <br /> po;t g� Mysz�-r <br /> CONTR.LICENSE M <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � �� p�/ ]�Electric _Gas_Olher <br /> .,�,r� -/ <br /> WORK DESCRIPTION R� p��� I�� �-L(,��y� ����JVGf' ���.C�w' 7 O�(J� W �N�w <br /> 5°`"` � , �i / �� '�=-��r�_�+c='f""i�r <br /> ��ItiCE Dry ��� 1�+s mvld � i!- � <br /> 6e�=i�,:r_e. _--� — -S%�c.-��w-rh�e . N�GU /�G�n t �+��e�"� a-p C y i u�s. <br /> UMBING MECHANICAL <br /> N , TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ NC-air handling units <br /> Bathtub _ Forced air systems <br /> Lavatory;wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer / Clothes dryer <br /> Water heater �v� Range hood <br /> Sink(service/barlmop/elc.) �, Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap � _ W�dstove <br /> Roof drains � �1 _ Other <br /> = Other 47ti �/1�p�� — <br /> , /I��� �.toL -��e — <br /> '� � // <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J706 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this lype of work will be complied with whether specified herein or not.The granting of a pertnit dce�iiot presume <br /> to give authority to vidale or cancel the provision of any other state or local lew regulating construdion or the pertormance of <br /> construction.That I am aulhorized by the owner oFthis property lo perform the work forwhich application is made end I comply with'ne <br /> Stale Contractors Law 18.27 RCW d 296. WAC. <br /> �i/ l4 2��o I " <br /> Signature of Owner/Contractor uthonzed Agent e�e l <br />