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' . ERMIT APPLICAI .JN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9fS201 <br /> 425-257-8810- FAX 425-257-8857 -www.e�aerettwa.org <br /> APPLI4ATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � /- I �/-O <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> o�-8U I �/,�f ��7��1-&S�. Q O�! ��l (v��0 0 0/r� c � 1- 0 3�0 <br /> LEGAL LOT NO. BLOCK TRACT OR SU9DIVISION# <br /> DESC. <br /> OWNER ADORESS CITY/ZIP PHONE <br /> �u " '�'I��r 6l�U����� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��F�.� � n �,�. 503 ��3-i9y�i� <br /> eana� <br /> � CONTR T ��� � �'� � I N <br /> U �G cQ-tut t �� �03� l�nn�.rtao CJr1 `180f� <br /> CONTR.LICENSE M P�G / `G����� L � µ2�-,�6--9� �i <br /> Q L G f� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �I (j-�K,��� _ _Eleclric �Gas_Olher ��Q� <br /> WORK DESCRIPTION � � <br /> ��� ��-�--1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXIUR[OR IT[M NO. TYPE OF FI%TURE CR ITEM <br /> Tuilc� A/C-air handliny unils <br /> �alhlub Forced air sys�ems <br /> Lavatory pvash basin) �_ Gas piping <br /> Shower Waler healer <br /> Kitchen sink&dispusal Gas fireplace <br /> Dish�vasher Gas range <br /> Clolhes washer Clothes dry•er <br /> Walen c�ater Range hood <br /> SinY,(service/bar/mop/etc.) Exhaust(an <br /> Back(low preventer Heat pump <br /> Urinal Unil hea�er <br /> Diinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease irap Woodslove <br /> Roof drains Olher <br /> Olher __ <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 7105 <br /> I hereby ceriti(y ihal I have read and e,�amined this application and know ihe same to be tiue and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specilied h�rein or nol.The granling of a permit does not presume <br /> lo give aulhoriry lo vioiate or cancel ihe provision of any o�her slale or local law regulating consWction or Ihe periortnance ot <br /> conslruclion. Thal I am authorized by lhe owner ol this property to pedorm Ihe work for which applicalion is made and I comply wilh ihe <br /> Slate Conlrac�o�s Law 1 7 lland 2�J6200 AC. � <br /> /' � <br /> /,�������C/-;�� 'J-t'i�CJ!' � �f /r '�7 <br /> Sic�nalure of OwnedConlraclodAidhurized Ageiri Dalo <br />