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I <br /> PERMIT APPLICATIdN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, 4NA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FRON! 8 AM 70 4 PM <br /> SITE ADDRF:SS PARCEL TAX I.D.# PERMIT# <br /> /.�� %1e S'� S/ ' 6:2_ 0� 7af� �v�`O�i -<<� <br /> LEG�L LOT NG. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER / ADDRESS CITYlZIP PHONE <br /> _,�! F� 1 CY V' �S '^—�7r! v2 �-�% I�140%F S / C(/{f-G� <br /> TENANT NAME I CONTACT FOR PE MIT F'HONE L�'�5�,3�37�/3 <br /> �L�Y(� �i v�yi,� F•MAIL <br /> NTRA O • � A DR S li I P <br /> lk,,,,�,.� c�„5� -r-�< </.�s-�-3�3 <br /> CONTR.LICENSE p vJ/���} ///� , /�O T��.L N� ,//r/ / <br /> �� 06 � / /� i�, vY. �i�12.� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � /c �[M�l �,��N<< _Gleclric _Gas_Other �3!U� � <br /> � <br /> WOR DESCRIP ON <br /> ;:��,�;f �3�:-�ti���,� � �dd�����-� G„� ��oGF. ��o �i�k, ���;� <br /> c,�r�' ��o .�-� . �/��-- �/a`'�v � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet _ NC—air handling units <br /> Balhlub Forced air systems <br /> 1 Lavalory pvash basin) _ Gas piping <br /> ! Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dish�vasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(servicelbar/mop/etc.) � Exhaust fan <br /> Back(lo�v preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodslove <br /> I _ Roof drains _ Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 9105 II <br /> I hereby cerili(y that I have read end examined this application and know the same to be lrue and wrrecl All provisions ot laws and <br /> ordinaces goveming Ihis type o(�•.xk will be complied�vilh whether specilied herein or not.The granting of a permit does nol presume <br /> to give aulhority lo violale or can�a� �ae provision of any other stale or local 12w regulaling conSUuclion or the pedormance of <br /> conslruction.Thal I am aulhorized by the owner o(this property lo pertorm lhe work for which application is made and I wmply with the <br /> Slale Contr�ct rs La�v 18.27 RCW and 296.200 WAC. <br /> :Cw� � �s/� � � <br /> Signal re o(OwnedContr C �r/Aulhorized Agent Dale � I_ , <br /> r�- <br /> ; <br /> - , <br /> � <br />