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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 <br /> SITE ADDRESS � PARCEL TAX I.D.# P MIT# <br /> gyZE G xq� ;<<-wA oo ���� cb� - �� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRE55 CINIZIP PHONE <br /> ��5� �Q �Nc��. �-- �'-�26 E x�,�;P � ,a. E-x<<� �,A�ZoFs �-y <br /> TENANT NAME CONTACT FOR PERMIT PHONE ��ZS'S�` - S.J b <br /> �6ATk� vOR� F�VJ S �I E•MAII�FR"tSN-�n�� S"1t �( ��S��i c <br /> . N 1'�31 Y�'Iq.1•C oM <br /> ��a�'is c�„sb � �1�.'��;L.c 1� �., �,a1.�7�. Atie <br /> CONTR.LICENSE k � (V�` 1` ` y� qp ZOII <br /> QL�v_15C Jt 1 (�k c ��� .-��.a i r, <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> �\.e S �Eleciric _Gas_Other �Z,j���� <br /> WORK DESCRIPTION <br /> � �ZcPl� ce ��:Sb.�� Ca,r��� b , .i.,5�<\� ►-r��..� b5�1-.-'rh��5�r.k �b �',le-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYNE OF FIXTURE OR ITEM <br /> � �_ Toilet _ AIC-air handling unils <br /> �_ �athtub _ Forced air systems <br /> �_ Lavatory(wash basin) _ Gas piping <br /> Showcr Water heater <br /> Kitchen sink& disposal Gas fireplace - <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> _� Water healer Range hood <br /> Sink (service/badmop/etc.) . _j_ Exhaust tan <br /> E3ackflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> I Floordrain _ Refrigeration � <br /> Grease trap � _ Woodstove <br /> Roof drains Other_ <br /> Olher <br /> CITY OF EVENETT LOCAL SALES TA%CODE IS 3105 <br /> 1 hereby certify that I have read and examined this ap�. ��.ation and know the same to be true and correct All provisions of laws and <br /> ordinances governing this lype of work will be complie:f with whelher specified herein or no�. The grantiny of a permil does not presume <br /> to give authonry lo violale or cancel�he provision of ar. �other state or local law regula�ing conslrudion or�Y�e performance of <br /> consiruclion.That I am aidhorized by ihe owner of Ihis property�o perform�he work for which application is made and I comply with ihe <br /> Stale Conlrac �rs Law 1827 RCW and 29G200 WAC. <br /> � a ` 6- �� 1 <br /> Signatur wned on�raclodAulhorizedAgenl Da�e 1/� <br />