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i-- -- --� <br /> PEkNiIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> II 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM N /�✓� / <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 0�70 7 1/ifwceE-sr �„t l?1 Oqn�j-C��� <br /> LEGAL LOT NO. 6LOCK TRACT OR SUbDIVISION d <br /> DESC. <br /> OWNER / ADDRESS CITY/ZIP PHONE <br /> ,�/� '��sa38- v�Y <br /> !/�� /� /(JE:f� p7707 /�/E't✓!_.Ae'ST AvE- G�Lf/C�TIr/9 9Pob 3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �/✓/!� `���E^ E-M>ILi6sK,-/�e�e�rA;� Ceif <br /> CONTRACTOR ADDRESS C1TY2 P PHON i <br /> CONTR.LICENSE# ��Ne/C <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> sin-G�! FAr) RC�JiO/ti« _Electric L Gas_Other <br /> WORK DESCRIPTION / • <br /> �YNdC( �4r�C '✓�uf '-Gf1S ���•�-G <br /> PLUMBING MECHANICAL <br /> ryp, IYPE OF FIXIURE OR ITEM NO. TYPE 01-FIXTURE OR ITEM <br /> Toilcl Ar'C-air handling units <br /> Ba1hWb / � Foiced air systems <br /> Lavalory(wash basin) 1 � Gas piping <br /> Shower W ater healer <br /> Kilchen sink 8 Cisposal _ Gas fireplace <br /> Dishwashcr _ Gasrange <br /> Clothes washer Clothes dryer <br /> � Waten c�aler Ranc�e hood <br /> Sink(servicelbar/moplelc.) _ Exhaust fan <br /> 8ack(low prevenlar _ Heat pump <br /> I _ Urinal = Unit healer <br /> Drinking Founlain Boiler <br /> I _ Floor drain = Re(rigeralion <br /> 'I = Grease lrap — Woodslove <br /> Roof drains Olher <br /> Olher — <br /> CITY O�EVERETT LOCAL SALES TAX CODE IS 7105 <br /> III hereby cerili(y lhal I have read and examined Uiis application and know Ihe same lo be Irue and correcL All provisions ot laws and <br /> ordinaces goveming this rype o(work will be complied with whether specilied herein or not.The c�ranting of a permil does not presume I <br /> ito r�ive 2ulhority lo violale or cancel lhe provision of any other state or local law regulatin9 consWction or the pedormance of <br /> cun<_'.ructio at I am aulhorized by lh�owner of ihis property lo perform lhe work for�vhich applicatior.is made and I comply wilh the i <br /> I Stale C ra rs Law 7 . 7 RCW and 296.200 WAC. <br /> -�,�r- y �` o y_ '�� <br /> S nature o(OwnedConlractor/Author¢ed AgeN a�� � <br /> I � <br /> I _ . . . _ . —� -�---- - --- --- ---- - —- <br />