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; <br /> PtRMIT APPLICATI(,,N , i �: �' <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.A� PERMIT# <br /> I� �w,o2e, �vereQ�"' I�G7U -O( <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> T � e�z s�► S«�e� Z4�e M�v�c S ,— '��1 E„�e�� W�+ 4asz�.tzo� <br /> TENANTNAME I CONTACTFORPERMIT PMONE <br /> ----" 2�Q Av�s, y2S?66. \12$ <br /> .b U S� e�a� beo�-eeOAya�ero��+Q . <br /> bry AMN�+CPw"`! ;}�`� ��` <br /> r �a -Y 1 b 6 1`4�13 A���1 LY,,., WY4 q9o5� gvo 9zz ��-o <br /> CONTR.LICENSE# /� q Y � I �� � ��y C� <br /> IJ � <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��,� �Eleclric _Gas_Olher <br /> WORK DESCRInPTION /� <br /> F�� PIAQ fR�.T �F �1•� W�tT�2 � WAST�, <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. IYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> � Bathtub Forced air systems <br /> 3 Lavatory(wash basin) Gas piping <br /> '2. Shower Water healer <br /> 3_ Kitchen sink&disposal Gas firepiace <br /> — Dishwasher Gas range <br /> = Cbthes washer Clothes dryer <br /> � Water heater Range hood <br /> — Sink(serviceNarlmop/elc.) Exhaust fan , <br /> �— BackBow preventer Heat pump ' <br /> ` Urinal Unit heater . <br /> — Drinking Fountain Boiler , <br /> — Floor drain Refrigeralion , <br /> — Grease trap Woodstove <br /> Roof drains Other �� <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerilify that I have read and examined lhis application and know the same to be Irue and correct. All provisions oi laws and <br /> ordinaces governing this rype ot work will be complied wilh whether specified herein or not.The grenting of a pertrit does nol presume <br /> to give authoriry t vioiate or cancel the provision of any other state or local law regulating construction or the pedormance of <br /> construction.T t I am autliorized� e owno f lhis property to perfortn the rk tor which application is made and I wmply wilh the <br /> State Conir rs Law 18.27 CW 296 0 WAC. � <br /> v.. Fj(/' 0 <br /> Signature of OwnedConlraclor/Authorized Agenl Date <br />