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PE�K11lIIT APPLICATION <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 �J -a�I�� <br /> SITE ADDRES�� � PARCEL TN(I:D.0 PF,R�JI�T# � <br /> � ; •-IC� J l� c� S '� ,�J r� � 1o� 55 � -�� 70� � �'� 2 <br /> LEGA LOTNO. ` BLOCK TIRA'CT ,/� �/ I � <br /> JCSC. 1 V ��) U 7 . C Y't � <br /> OWNER ADORESS 21P PHONE <br /> l�,s,�� �a � � c�c�..� ��1 '�G 5� 1 �� �r�5 J I�' � �'c� `�Z�-Z58�31 � <br /> TENANT NA E CONTACT FOR PERMIT PHONE <br /> .�.��% � O��iL�k `� �I2�- Z. S� � �.�ill <br /> CONTRACTOR AUDRESS CITY2IP PHONE <br /> CONTR.LICENSF N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � /��r �����C <br /> ��� � 171 Eleclric _Gas_Olher � <br /> 0�. <br /> WORK DESCRIPTION p �����_ � <br /> � c� G� i�l lJ >U D�l \ ��'�'t�/Y���-- - 1 iv ) 1'�) � ��- -`�� <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FI%TURE OR IT[M NO. TYPE OF FIXTURE OR ITEM <br /> Toilct A/C—air handling unils <br /> Bathlub Forced air systems <br /> _�_. Lavatory(wash basin) _ Gas piping <br /> �_ Shower _ Waler healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Cblhes dryer <br /> Waler healer � Range hood <br /> Sink(service/bar/mop/etc.) � Exhaust(an <br /> Backtlow prevenler _ Heat pump <br /> Urinal Unil heater <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Rool drains O�her <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify lhat I have iead and examined this application and Anow Ihe same lo be lrue and correct. All provisions of laws and <br /> ordinaces goveming this type ot work will 6e complied with whelher specified herein or not.The granling of a permil does not presume <br /> lo give aulhority to violate or cancel lhe provision of any other slate or local law regulating consUuclion or lhe performance of <br /> wnsiructiun.Thai I am authorized by thc owner of this properly lo perlorm the work for wh�ch application is made and I comply with the <br /> State Contractors Law 1 27 RCW and 290200 WAC. <br /> Sig��� � , ��� � � <br /> L �" <br /> ot O nedCon r lodAuthorized Agenl Dale � <br /> 2 <br />