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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> d25-257-8810-FAX 425-257-8857 -www.everettwa.org I��� G!__2D <br /> �rUi. [E� <br /> Q APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � � pERMIT A <br /> SITE ADDRES � PARCEL TAX�•D.K 6�'S O jI U � � <br /> �{ , wd ve o o Y <br /> LEGA OT O. BLOCK 71tACT � �1� <br /> DESC. <br /> '�T Of v f ���- <br /> OWNER ADDRESS CITY2IP I, _N���,� Q � ��0 <br /> .� <br /> �I`P�a ((�uuM �a �� �5.� � �/'Da���4,c �190 3 �v�Ho� W/� <br /> TENANT NAME CONTACT FOR PE MIT <br /> �{ C� �C/`''t'Oov ���raYif—� �0� <br /> CONTRACTOR ADDRESS CITY2IP PNONE <br /> CONTR.LICENSE M <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> 5 L` �Electric _Gas_Other <br /> f [f <br /> WORKDESCRIPTION /�e� IG �Q ��UMp ' �",� �l4' � GUS FN/f/4AGC � w� ��� 4 '�Q��R� <br /> ��. <br /> ��t � �� �-j � �t � t�; t(�N ' r l '' ,, <br /> i <br /> PLUMBING MECHANICAL <br /> NO. <br /> TYPE OF FIXTURE OR ITEM NO. TYPE OF FO(TURE OR ITEM <br /> � Toilet A/C—air handling unils <br /> Balhlub _f_ Forcedairsyslems <br /> � Lavalory(wash basin) � Gas piping <br /> Shower Water heater <br /> J_ Kilchen sink 8 disposal _ Gas fireplace <br /> �_ Disliwasher _ Gas range <br /> � Clolhes washer Cblhes dryer <br /> �_ Water heator � Range hood <br /> Sink(service/bar/moplelc.) � Exhauslfan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Founlain _ Boiler <br /> Fioor drain _ Refrigeralion <br /> — Woodstove <br /> _ Grease lrap Olher_ <br /> Root drains — <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAl(COUE IS]105 <br /> 1 hereby ceritify lhat I have read and examined this application and Anow lhe same to be true and correct. All provisions oi laws anA <br /> ordinaces goveroing this type of work will be complied wilh whether specified herein or noL The granting of a permit does nol presume <br /> to give authoriry to violale or cancel the provision oi any other state or local law regulaling construction or the perfortnance o( <br /> conslruction.That I am authorized by the owner o(this property to perform the work tor which application is made and I comply with lhe <br /> Slale Contrectors Law 18.27 RCW and 29G.200 WAC. <br /> (���, / if��..�-- 1/�y��y <br /> 3Yg ature o(OwnedConlracbdAulhor¢ed Agenl Date <br />