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� � f <br /> PERMIT APPLICATION <br /> CITY OF E`iERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.or!� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �(� I PARCEL TAX I.D.ii PERMIT N <br /> � �0�� - b33 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION f <br /> DESC. <br /> ONMER ADDRESS n CITYl.?IP PHONE <br /> - 1/1�l ✓L-- �?I I � /'�� i + .� 1������! t�� a�� <br /> TENANTNAME CONTACTFORPERMIT � PHONE�-�j��G����.L_G�ICiGi <br /> I/� �A vu-CJ l <br /> '`I ` fC/�"IiVI�I.\ ��� E-MAIL 71UC��'[[/I'll //�LI� <br /> �rtcl�v�;�..�2 �4��,' "] u,oa t��,c�c2� �',{��// ' Q-+-2�►� <br /> CONTR.LILENSE�► �����/ � -ul i r�,��� �"`��"w'�� '`L�`y���7' L��GU>��G7"c� <br /> '�n1DNGE�i, ,�f-X�L 11IG1 —(�0� (� �� l 1 <br /> USE OF BUILDING HEA7 SOURCE CONTRAC7 PRICE OF WORK <br /> �[Electric _Gas_Other I� '��(��_ �� <br /> WORK DESCRIPTION / ' <br /> .1-►�"�c� I� -Zl.��� h�--� �OZU'lZ� ,`7i�126'\� <br /> 01,���-ot��' ��i,�i� � b� �OZ d�u� , -� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> _ Toilet AIC-airhandlingunits <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shovrer Water heater <br /> _ Kitchen sink 8 disposal Gas firepl�ce <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> _ Backllowpreventer Heatpump <br /> Urinal Unit heater <br /> Dnnking Founlain Boiler <br /> _ Floordrain Refrigeration <br /> _ Grease trap Woodstove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 1705 <br /> I hereby certify ihat I have read and examined this application and know the same to be Irue and cortecl. All provisions of laws and <br /> ordinances goveming this type of work will be complied with whelher specified herein or not.The granting of a pertnit does not presume <br /> to give aulhoriry to violate or cancel ihe provision of any other state or locai law regulating consiruction or lhe peAortnance of <br /> conshuction. That I am authorized by the owner of this property to perfortn the work for which application is made and I comply vAth the <br /> Stale Contraclors Law 1827 RCW and 296200 WAC. <br /> ���� �G �a -�--- Ll � 1I l lU <br /> Signature of Ov.�nedC IractodAuthonzed Agent Date <br />