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( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8610-FAX 425257-$857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM a AM TO 4 PM <br /> SITE ADDRESS ,1 PARCEL TAX I.D.+� PERM�T�,� C <br /> � � �i[ �i_h:� i , / ��'bL �'ici �'I [ '1i.'G�.-' _ ,!- �0� <br /> LEGA LOTNO. B��CK TRACT <br /> DESC. <br /> qyN� ADDRE55 CRY21P PHONE <br /> � � � t � ���•� ' -i'� �Y i'/C�"/ !-� . �'�.�r,' iic.- 7 <br /> l � L !l / ' . �• � • <br /> 7ENANTNAME I CONTACTFORPERNfT P�E <br /> �- C l /i r J '.t� � ('� �� _. n YI'N '�.,... ='/ % ' J c ^ _ <br /> COqNTRACTOR I / ADDRESS -� CT'fZIP PHONE <br /> .%/�('/-Hf' �V:tit, �n,�c ' %,fc (� /�•��'i'�:�,.!' �f ;c� .:'C'e • �"J✓.;�utc �t.i"' .� . _ � � -� �' <br /> CONTRLICENSEN � jJ,�)�� <br /> �Ji�c�i � n� / r•.r/i� �. ;� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � Electnc _Gas Other ,.3'�iUCU. - � <br /> .�^ rNc",t'� �. � a — — <br /> WORK OESCRIPTION <br /> ,'.,.. i„�l �� i�/�... ,,., r. ,i �ri/. . .. _ , . . .. . . ... . _�. � � ., . „ ... � . . � ,. .. .i., . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF Fl%NRE OR fTEM <br /> Toilet A/C-air handli�g units <br /> Bathlub Forced air systems <br /> Lavalory(wasli basin) _ Gas pipirp <br /> -- Shower Walerheater <br /> Kitchen si�k 8 disposal _ �g�'�� <br /> Dishwasher �5�� <br /> Cblhes washer Gulhes dryer <br /> Laundry vay Range hood <br /> Sin4(service/bar/mop/elc.) _ 6chaust fan <br /> Badcllow provenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking FwnL3in — ���� <br /> Floor drain Refnperatior. <br /> Grease Uap _ Woods�ove <br /> Roof drains OU'� <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> I hereby a3nlity that 1 have mad and examined this appficalion arW know lhe same to be true anG rnrtecL All provisions of laws and <br /> wdinaces goveminc�Ihis lype of worie will be canplied with whether speafied twiein or roL The granting of a permit does ral presume <br /> to give aulhonty lo violalo or cancel Ihe provision of any o�her s4ite a local law regulaling consltuc6on o/Ihe performance o( <br /> consWclion.Thal I am autliorized hy lhe owner of lhis property to perform the work for whi:h application is made and I comply with Me <br /> State Contradors Law 78.27 RCW and 296.200 WAC. <br /> � _ . _ .. . . ,_-Y » - �/r il��! � <br /> Signatura of OwnerlConVactorlAulhonzed Agen1 Date `� <br />