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r <br /> PrRMIT APPLICATION <br /> CITY OF EYERETT 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 3 r-�,� —D Z <br /> SITE ADDRESS r�<� W� PARCEL TAX I.D.# P IT# <br /> � 7 � , ��v st 2� H3 o63GY5oo � - <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITY2IP PHONE <br /> �,/� •�r1y H�.5�.13°3-�>�/o <br /> J cAw.v /"\U e..v. � .. _.�,� fi�v r=7� N(- �O.Q MT, L`l.en��� 1ni/=� �i�7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> T/n n�FS ,-,-� ��.,,/ y.�_5 a_3�, 4'-3� J <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSEp jF C_ r /(�/1)C .7�rjt/� ,� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas Olher <br /> WORK DESCRIPTION <br /> �LY�()`�v4\ �` C�r✓.^21�C� <br /> l) <br /> PLUMBING MECHANICAL <br /> NO. T/PE OF FI%TURE OR ITEM NO. TYPE OF FIXNRE OR ITEM <br /> Toilel A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kilchen sink 8 disposal Gas freplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water hoaler Rango hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Orinking Pountain Boiler <br /> Floor drain Refrigeration <br /> Grease irap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> I hereby ceritify lhat I havo read and examined lhis application and know lhe same to bo true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> lo give authonty to violate or cancel ihe provision of any other state or local law regulating construclion or lhe periormanco of <br /> construction.That 1 am authorized by tho owner of this property to perfortn lhe work fer which application is made and I rAmply with lhe <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> \ .�C' � � 1 �\ � /���`-E=^.-. ��-i� � - � <br /> SignaW ot Owner/ContractodAulhonzed Agent Date <br /> �l <br />