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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-881 U— FAX 425-257-E 357—www.everettwa.org I 71 z - d I� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 nM /' <br /> — Q'H�-- <br /> SITE ADDRESS � PARCFL TN:I.D.# PENMIT# <br /> c 5 ie ue,�s -�c�� b��.o � � �a�� a o � 300 ��,�<�-�'_ <br /> LEGAL LOT NO. BLOCK � TRLACT OR SU�1B..D,IVISION R � --- --- - <br /> DESC. I Oi���( ,�V o. U"��� _ <br /> OWNER ADDFF.SS CITY/ZIP �HONE <br /> j _ �� "�.�`0.2 <br /> /� iac z �. i�c �- ;�;,- l , » ::: ��s �ti�;� �, 1zn ��� issi,�;U,�ii.u.� <br /> � ;.;?: r�/v+ h,.� �n.,t�lr <br /> T <br /> TENANT NAME CONTACT FU3 PERMIT PHONE � <br /> � I E-MAIL <br /> A R ��r_y 'S PIUy R I _ — <br /> - --- ;.,r��3 133 h� s c <br /> CONTR.UCENSE N � p i' <br /> c2��'y � � � <br /> J� – �U �UO /p �a) � U `� IL'a �7oitit�S� lw,rs �/�S'7G0-,�4( S <br /> USE OF BUILDING HEAT SOURCE I'J C6 TRAC� T PRICE Uf WORK <br /> � L��r� �}t p K� I�,�� � _Electric �Gas_Other .X/ G/ Gp U U✓ <br /> I l — � I <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. NPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> /� Toilet _ A/C–air handling units <br /> .Bathtub Forced air systems <br /> r� Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen:.�nk 8 Aisposal Gas freplace <br /> Dishwasher Gas range <br /> hes washer Clolhes dryer <br /> /_ Waler healer Range hood <br /> Sink(serviceNar/mop/etc.) Exhaust tan <br /> Backflow preventer Heat pump <br /> Urinal Unil healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigera�ion <br /> Grease trap Woodstoee <br /> Roof drains OUier <br /> otner <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y thal I have read and examined�his applicalion and know the same to be lrue and correct. Ail provisions o(laws and <br /> ordinaces governin�this type of work will be complied with whether specified herein or nol The grenling of a permit does not presume <br /> to give authority to violate or cancel Ihe provision o(any other state or local law regulaling construction or the performance of <br /> conslruclion. That I am aulhorized by ihe owner of ihis property to periorm lhe work for which application is n�aAe and I wmply with Ihe <br /> St e onlractors Law 1 7 RCW and 290200 WAC. <br /> � � ����7��- /,���--D� <br /> -na ure of v edContractodAulhorized Agent Date <br />