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- <br /> PERMIT APPLIC�ITION <br /> �ITY OF EVERETT PERMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, b'JA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 5'�- � —O� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> --�'oG� �o,��i�,,�L� A✓� ��-ov,� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER �l ADDRESS "'���l CITY2IP PHONE <br /> �s��� o�,�.��r�u; �o �.� //��/ J<���u/18vi9 ��. S9r /a.11 <br /> TEN�NT NAME CONTACT FOR PERMIT PHONE <br /> �. <br /> ���i=1� <br /> CONTRACTOR AD�RESS CITY/ZIP PHONE <br /> CONTR.LICENSE# ( � <br /> � (� i,t � .�� �j{.�d,—r i <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Olher <br /> WORKUESCRIPTION ���/c✓cl t.l-i:-i.�/� �jl�vN�✓/<t� �'i.G'inl�I j ✓�E.O'/�c•t /.�.�in-� <br /> /! n � � <br /> /./L-!t� %[E.�i��C� (/'/N�•J� , a�Ci�1/'c'c !-/X'i��E'S <br /> PLUMBtNG MECNANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling unils <br /> / BaQitub Foroed air systems <br /> ` —T Lavatory(wash basin) _ Gas piping <br /> �_ Shower __ Wat�r heater <br /> � Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> ( Clolhes washer Clolhes dryer <br /> Water heater Range hood <br /> �. Sink(service/bar/mop/etc.) _ Exhaust(an <br /> / Bac!cflow preventer Heat pump <br /> � � Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Greasetrap _ N'oodslove <br /> Root drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I haca read and examined this application and know the same to bo irue and correci. All provisions of laws and <br /> ordinaces governing this type o(work i+!ill be complied with whether specified herein or not The granting of a permil does nct presumo <br /> lo give authoriry to violate or cancel lhe provision of any olher stale cr local law regulating co�struction or lhe pedormance of <br /> conslructior..That I am authorized-by tho ownor of lhis property lo polorm the work for which application is made and I comply wilh the <br /> State Contractors Law:t�127 RCW and 29�.200 V�'AC. <br /> � i <br /> ( L!'.G�� S/� �� 7 <br /> S�iaat��re oi Owner Goiriractor/Aulhorized Agent Date <br />