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f� <br /> �jll <br />�F� � F �RMI�' APPLICAT'IuN <br />�°�;��¢1� <br /> "'-'� ' C17Y OF EVERETT PERMIT SERVICES <br />; };� , <br /> ,:. <br /> ; =i ; 3�200 CEDaR STREET, EVERETT, 1NA P820'I g �C)� l l � <br /> 425-2,7-8810 — FAX 425-257-8857—www.everettwa.or C)', 1 <br /> � �lJ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NUT ACCEPTED <br /> _.,�, . SITE ADDRESS PARCEL TAX I.D. # P MIT 9 <br />, a L' ) <br /> '�';�''�' _ T!S �� �.5� �- �� �Q/ _7 <br /> a..�. <br /> �' LEGAL LOTNO. � BLOCK TRACT <br /> r `.`�`'�z''i nesc. ;Z 9 Cct�rrr.L�� <br />� �.j:�j i OWNER � ADDRESS CITY/ZIP PHONE <br /> np�. W s� r / <br /> i /1�� i�2Y'(' L� �L C /n�0/�ax r//D ��Cc>�-4� rJS 2.7 6 `f 2 S-Z 3 3 Sr 2 z y <br /> I TENANT NAME —� � CONTACT FOR PERMi! PHONE <br /> I 'T�yz� �i-�, �Go 9�9- /93 3 <br /> 1 — <br /> � COlJ�fjA�T� /f i - J�L�, ADDRE 5 CITY2IP PHONE �'� <br /> /� �� d��L�( Cl�=''� <br /> CONTR.LICENSE# p �- � <br /> �/�if%�C.0 �l` O/Z L //D�cjf `J/o ��zCo+, �z,� L J c�a--.�S�J- ',�6cy I <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK I <br /> �y 4� � �u�f; ���„u _Electric _Gas_Olher O 9 ys U <br /> / �/ <br /> WORK DESCRIPTION <br /> ��� �-!�>--u - S f� �. � �l - '? � � -�' <br /> � - �/ , - --C-_�� <br /> � � <br /> PLUMBING MECMANICAL —"" <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> >' Toilet NC-air handling units �- <br /> �� Bathtub Forced air systems <br /> �ILavatory(wash 5asin) � Gas piping <br /> Shower / Water heater <br /> � ;(itchen sink 8 disposal � Gas fireplace <br /> ( Dir.tiwasher Gas range <br /> � Clothes washer Clothes dryer <br /> _ Laundr�tray Range hood <br /> Sink (service/barlmop/etc.) L Exhaust fan <br /> � �ackflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> I = Grease trap _ Woodstove <br /> Roof drains Other <br /> i = Other I — <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> � <br /> � I hereby ceritify that I have read and examined this applicatior and know the same to be true and correct. All provisions of laws and I <br /> � ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does noi presume I <br /> jto give authonty to violate or cancel the provision of any other state or local law regulating wnsWction or the performance of I <br /> construction. That I am authorized by the owner of this propeRy to perform the work for .vhich application is made and I comply with the <br /> � State Contractors Law 1827 RCW and 296200 WAC. � <br /> i ��,��/�— ��— �/�z/os ,� ; <br /> Signa ure of OwnenConvac'ovAuthonzed Agent Date � <br />