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PERMIT APPLICATION <br /> CITY OF EVERETT PERNiIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-f3810- FAX 425-257-8857 -www.everettwa.org <br /> / _��'� -a� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � <br /> SITE ADDRESS PARCEL 7AX I.D.£t PERMIT p <br /> ,3 �f,�D T/ �, ��� � D - ,32 <br /> LEGAL LOT N0. BLOCK TRACT OR SUB�IVISION N <br /> DESC. <br /> Ou'NER ADDR[SS CITYi21P PHONE <br /> h,� s�ve,,«,/, 3��zr� �//�, �C �`v�.-<�yg�, ��zs- zsz- iz6 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> NCTRACT R ADDRESS / IP O E <br /> L- �/�n �fr- J�n�i�9 '*�'S�i✓�'� L .�l(r O� �U'tit.���C_ C/2 5 ' Z� y' Z��/ <br /> CONT�i LICENSE# ��'Z[7� <br /> �5'�.�n.'S s n y z�� z - <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � ��=- <br /> ��5 �Electric __Gas_O.her �T J <br /> WORK DESCRIPTION /� <br /> ✓1 f mOG�Y tt�1�/^t/O� K �Y.t �j%'�f i�s� � /7i'�'�4i��f�fi"' <br /> i <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. NPE OF FI%TURE OR ITEM <br /> Toilet � NC-air handling unils <br /> Bathlub f-orced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower __ Waler healer <br /> Kilchen sink&dispasal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washr.r Gothes dryer <br /> Water healer Range hood <br /> I _ Sink(service/bar/mopletc.) Exhausi fan <br /> Bachflow prev�nler � Heal pwnp <br /> � Urinal _ Unil heater <br /> � Drinking Fountain Boiler <br /> �� Floordr2in � Woodstavlen <br /> I _ Grease irap _ <br /> Root drains Olher <br /> _ Other _ — <br /> I i — — — <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 3105 <br /> �hereby cerilify th2l I have read and ezaminr,�d lhis applicalion and know lhe same to be lrue and correcl. All i�rovisions o(laws and <br /> ordinar,es governing this lype ot work will be complied wilh wl-,ether speci(ied herein or noL The granting o(a permil does nol presume <br /> � lo c�ive authority to violale or cancel lhe provision of any oth��r slale ur local law reyulating construclion or lhe performance of <br /> i cons�ruclion.That I am authorized by the owner of this prcperty to pertorm the work lor which appiication is made and I comply wilh lhe <br /> , Slale Contr2ctors �w 18.2J RCW.and '296.200 WAC. <br /> ll�L -L irL � '�� � ���-O � < r^ <br /> Signature of OwnedCoNraclodAuth�.�rized Agent Dale � �JO�� ' � � <br />