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f " <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 %� 7�_�� <br /> � C/ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �p�./3.r/(� <br /> SiTE ADDRESS PARCEL TAX I.D.N P�RMIT# <br /> l �f-z 5 rf�r��c�e ��• �o3q yS�l o l �o L O -UD <br /> LEGAL LOT NO. BLOCK TR OR SUBDIVISION# � ( <br /> DESC. i Q �V'eF^�(' 'f"IC�) S <br /> OWNER AD RESS CITYIZIP PHONE (�,zS <br /> �lCE-4r�� C��� I�-tz� T�f-�r�-ev-e bf. �z�e��e�-t� 35q-��o . <br /> TENANT NAME/ CONTACT 1FtO�R PERMIT PN��„ S —'7 sq—'�(O(�j � <br /> /�/ �j— �IC I�f"l�l-K�'� CO� �� E-MAIL <br /> ���072 r D �s S C IZI S� S�NE <br /> �CCS-F2rti✓��tslti �uf�t-f� v�t �-0, -- 10`T�g zs'�l <br /> CONTR.IICENSEp ��Cf-��C���j �L�l� �� S�"� �����/ U/{- Yg?S g <br /> USE OF B/UILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��o>� �tLC� CL�� _Eleclric �Gas_Olher �(�� o O J <br /> �� i <br /> WORK DF�SC�I�ON � � ro�� � /1 � L��� �f � <br /> cj �C 'I <br /> � w� c � i'00 u.� �� <br /> i'Vl.ltc�'4-�n"l9CGQ d'd U�tn �l- � � � <br /> — PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE QR ITEM <br /> � Toilel .NC—air handling uni�s <br /> � l3a�hlub � Foiced air syslems <br /> � Lavalory(wash basin) _ Gas piping <br /> � Shower _ Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwashcr Gas range <br /> � �C' Clolhes wa:her �� Cbthes dryer <br />� ��f Waler healer Range hood /� <br /> � v Sink (service/bar/mop�alc.) .� Exhaust fan �Z, 7—G( �1 5 <br /> I 7� Ba:kllow prevenler � Heat pump <br /> Urinal Unit heater <br /> I _ Drinking Founlain � Boiler <br /> Floor drain Refrigeration <br /> Grease Irap _, Woodstove <br /> Rool drains _ Olher <br /> Olher — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby certity thal I have read and examined this applicatien and know Ihe same to be true and correcl. All provisions of laws and <br /> oidinances govemin�this type of work will be complied with�vhether specified herein or noL The granting of a pemiit does not presume <br /> lo give auihoriry to violate or cancel the provision of any other state or local law regulating consiruction or Ihe pertoimance of <br /> consfru lion. That I am authorized by Ihe owner o�this property to perform the work for which application is made and I comply with the <br /> Stat��ptracl9rs L�aw 78.27 RC and 29G200 WAC. <br /> / � ' , �' � t. �g '/U <br /> � Dale �/ <br /> Si� naWre of OwnedConlracloA uth ized AgeM �Z <br />