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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 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���a,c� _�O <br /> SITEADDRESS �:�rv`-'�{� PARCELTA%I.D.If P RMIT# <br /> �l;'-i J,�Y�;��NZ wr,y j�i wTj Q�J Q, i;�'1 ,� � �1 � Q _ <br /> L[GAL LOT N0. BLOCK TRACT OR SUBDIVISION M <br /> eEsc �j(� <br /> OWNER AD�RESS CITY2IP PHONE ��,(. -3SI "E`IG'-� <br /> ��.�r,-i�.l� �riv�5 `'��`i Ver�,12V1C �'��t S�' L.'�'V'Ft-1 �ufl 9�Z0 j <br /> TENANT NAME - CONTACT FOR PERMIT PHONE r��G 771 6'�C'-1 <br /> N� .J J�Y Y�l 1- =�i V� S E•MAIL <br /> NTRA A I / 1 � .c <br /> CONTR.LICENSE k �� I�,YI� <br /> USE OF BUILDING HEAT SOURCE CON?RACT PRICE OF WORK <br /> {�<�wl�. I �Electnc _Gas_Other •(l,tj'�"� ��..,;;' - , <br /> IWORKOESCRIPTION �t.I�' �4 -C`Ir.;.�. CiCCV. C Ir�X �1�.� � � Gr�C� .r7�iG�ir�� Clp�r � /Pt�.l�% �'`NL'- <br /> I C�.IV({Y�(U� ��t�IC� • <br /> PLUMBING MEGHANICAL <br /> Nr�, TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Totlei _ FVC-air handling units <br /> BatF�uU __ Forced air syslems <br /> _ Lavatory(wash basin) Gas piping <br /> ShowCr _ Waler heater <br /> rotchen smk&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water healer _ Rang=hood <br /> II Sink(servicelbadmop/etc) _ Exhaust(an <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> _ Dnnking Fountain ,_ Bniler <br /> Floor Arain _ Refrigeration <br /> Grease trap Woodstove <br /> Roofdrains T Other 1�''��� <br /> Other �-- `I'nr ` <br /> — i Gt�l�4- A�--�Mc=V� ��'S��Ic'�l <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3705 <br /> ', I hereby c=Ady that I have read and exammed Ihis application and know the same to be true and correct. All provisions of laws and <br /> ' ordinances goveming this type of work will be complied wdh whether specilied herein or not. The granting of a permit does not presume <br /> to grve authordy to violale or cancel lhe prowsion of any olher state or local law regulating construction or the pertormance of <br /> conslruc6on. That I am authcrizeA by the owner o(this property lo perform lhe work for which application is made and I comply with the <br /> � State Contraclors Law 1827 RCW and 296.200 WAC <br /> � ,i` �� f�:r�� '- _ ��:: <br /> � Signatu�e ol OwneriContractorlAuthonzed Agent � Date 1/ <br /> I Z <br />