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�'�� � ` �` `� <br />PcRMIT APPLICATI�.i� <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 />�- f o�0 3 � <br />SITF ADDRESS PARCEL TAX I.D. # PERMIT # _,/ <br />�c , � , �- �o�i o3oec��-IuOc ,_� --i• _ - <br />�� l�. �,c � ��d0 9 � �- <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION il , � <br />oesc. l-117 C,,..,.,.�.�,,i-rs�.-�,T-r� D=�-�.y�,v;i.c.z <br />TENANT NAME <br />coNrnc� rurc rtHmi� <br />�- , <br />L. -(� j'�' ��� i,R_ � l.� .l L•__ <br />CONTR. LICENSE q /V/ /l� <br />Il <br />US[ OF BUILDING <br />HEATSOURCE <br />Electric _ Gas _ Other <br />z.S- <br />/3 - <br />r.� Z � - � � � - tr � ., <br />(".NTRACT PRICE OP WORK <br />N�� <br />WORk .iSCRIPTION <br />�'D� 1 N' ��D ` 0�" i v �/�C� sy0 � d r f�o�s� �d2 ,'(��� r`�X l� <br />�z vsnl (r (��J.�^ � .�D �JJ(LK- s/-ivP_ cJ � <br />�'p ���� �� tJmQyrJGJ/1'! �GJiAit/LGA-� ���/i,�c� 1 `{�` I <br />PLUMCiING � �JIE�HAN��A� <br />NO. � TYPE OF FIXTURE OR ITEM <br />Toilr.t <br />� �athlub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishtivasher <br />Clothes washer <br />VVater heater <br />c�.,� ���n��rn/har/mnn/ntr. 1 <br />Back(Iow prevenler <br />Urina� <br />Drinking Founlain <br />Floor drain <br />Grease trap <br />Roof drains <br />Olher <br />NO. I TYPE OF FIXTURE OR ITEM <br />AIC – air handling units <br />Forced air syslems <br />Gas pi�ing <br />Water heater <br />Gas tireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Ezhaust fan <br />Heal pump <br />Unil heater <br />Boiler <br />Refrigeration <br />Woodslove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this applicalion and kno�v the same to be lrue and wrrecl All provisions o( laws and <br />ordinaces governinc� this type of work will be complied with �vhelher specified herein or noL The granling of a permit does not presume <br />lo give aulhority W violale or cancel the provision of any olher slate or local la�v regulating construction or the performance of <br />construction. Thal I am authorized by lhe owner o( lhis prupertv to perTorm the �vork for which application is made and I compy� wilh ihe <br />Slate�rect rs w 1d.27 RCW and 296.200 WAC. <br />� � � � �� _�—i� <br />Si�nalure o( OwnedContraclodAulhonzed Agenl Date <br />i <br />�-- - --- _ - _ ._. _ . __ <br />Z <br />