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' — <br /> PERMIT APPLICATION <br /> CITY UF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STREET, EVERETT, V�iA 98201 <br /> 425-257-8810- FAX 425-257-8857 -wvnv.everellwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 �"I g-v� <br /> SITE ADDRESS _ P��I PARCEL TA%I.D.# PERMIT p <br /> ' 0 ; C � �v �� � , cz � I �G�� � o� aa-� �� <br /> LEGAI LO7N0. BLOCK TRACT <br /> DESC <br /> OWNER AD�RESS CITYIZIP PHCNE ' <br /> doun��nU�e ,� P6 LzC �crtioc� S.Cen�Er P�.��i.�tr ��o2s�at�e981S8 <br /> TENANT NAME CONTAC7 FOR PERMIT PHONE <br /> A�1}. �/i �U �I;lCIY'�:;5����"�� I �111'�1 ��-nn �c�`_�����.�C'- (�g� <br /> CONTRACTOR AODRE55 �� CITYIZIP PI10NE <br /> Srni�11� ��rC� SUShe.ms ,l�'IC. IIGIo-��lib� Fl�2E �C�cc�n2aq�F2i�Ca.s�q2(a-18�0 <br /> CONTR.LICEHSEM�����_��1� I������ — <br /> USE OF BUILDING kiEAT SOURCE CONTRACT PRICE OF WORK <br /> I _Electric _Gas_Olher �/y/ /9� —� <br /> _r <br /> WORK DESCRIPTION <br /> � ��i,5ici��sl,u�ll ��Stcill CL l�)C�1- �(�� 5 rink�2� S�1S�r�F <br /> Sm�iS, �� � � <br /> (Oi�PC{ }1�e .� r�or � tQ�h 1UUi1cl�V1 �e��JrP(� �� C1r1d �N�C C��� , <br /> -ve� if". � ��h �i�" �S�S1��f�1 ��II I � � � T� C� � C-� � .lt din � ���"� f� ' '��5� <br /> PL MBING ECHANICAL ' <br /> NO. TVPE OF FIXiURE OR IT[M H0. T1'PE OF FIXTURE OR ITEM <br /> Toilet _ AIC—air handling umts <br /> �athtub _ Forced air systems <br /> Lavalory�wash basinl _ Gas piping <br /> Sho�ver _ \Naler heater <br /> Kdchen sink S disposal _ Gas Greplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Laundry Iray _ Range hood <br /> Sink�service/badmople�c) _ E*hausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> __ Dnnking Fountain _ Boiler <br /> Floor diain _ Relrigeralion <br /> Grease trap Wcodstove <br /> I Rooldrains _� Other lG�cj� <br /> Other — — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J705 II <br /> I he�eby cerdily Lial I liave read and examined lhis application and know lhe same to le true and correcl. All provisions o(laws and <br /> ordir,aces goveming thls q�p�:of�vork�eill be compVed with whether specifed herein or nol.The granting of a permit does nat presume <br /> to give authority lo violate or cancei the pwvision ol any other slate or local law regulating construction or the pedormance of <br /> const�uction That I am aulhonzed by Ihe owner of this ptoperly lo pertorm lhe work for which application is made and�comply wilh lhe <br /> State C��actors Law 1827 CW and 296200 W� �/� � <br /> L.)lu��e�� ��«vr���� I'�K '/ <br /> Signature of OwnedC nlraclodAuthonzed Agent ate 2 <br /> I <br />