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PERMIT APPLICATION <br /> CITY OF EVERETT PER4AIT SERVICES <br /> 3200 CEDAR STREET, EVERcTT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www•everettwa.org <br /> ppPLICATIONS ARE ACGEPTED FROM 8 AM TO 4 PM �l�"�J�(� �.� �v <br /> SITE AODRESS PARCEL TAX I.D.fi _ P RMIT# , <br /> � �"<, , �,/ 3�� gov36��o/d�,Fr9o�,�`��tCl �0:0�, .�,-�� ��7) <br /> /�v S�j �f�f-..T . <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION 7! <br /> DESC. / 6/E'?wrcr/Ca� , � G�O�--��' <br /> OWNEH ADDRESS CITV2IP PHONE <br /> C��6l,�rF�''rr,���;� Nr�f�i�z�Fsf�C �ly -��G�' <br /> TENANT NAME nCONTACT FOR PERMIT PHONE �'fj�s�f„s�(JJ� <br /> UA��✓c[/"i�b��fT E.MAILc�CJ.tfsll72'SJF .C'/�%/7 •'(jf7 <br /> �.Vh. <br /> I �y�E..,�l�o..,� �z�zsf�,�A��:xrF;sre'I,F,y�:Vs- ��:0%/%2� z�s�s�/ <br /> CONTR.LICENSE#,1 fFf/JC�j�jy�'! r <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � r� ������C� <br /> f��/�� .�li����/l�-jq'�c�C l`' _Eleciric �Gas_Other <br /> i <br /> WORK DESCRIPTION . <br /> NEr yy �O.i1%�'�(lY/Cti/f <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel �1 A/C–air h.-ndling units <br /> 'j� l_j___ Bathtub �� � Forced air systems <br /> � Lavatory(wash basin) �� � t .T Gas piping <br /> � Shower U � Water hea+er <br /> / Kitchen sink&disposal ��G Gas fireplace {� <br /> Z Gas range <br /> � D'shwasher � Clothes dryo� <br /> /_ Clothes washer � Range hood <br /> � Waterheater � Exhausttan +i� � ��� <br /> I� Sink(service/bar/mop/etc.) Heat pump <br /> Backflow preven�er Unit healer <br /> Urinal — goiler <br /> _ Drinking Fountain � Refrigeralion <br /> Floor drain Woodstove <br /> _ Grease trap Other <br /> Roof drains -- <br /> Other -- <br /> CITY�F :VERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be irue and correct. All provisions ol laws and <br /> ordinaces geverning this rype oi u++ork will be complied with whether specified herein or noL The granting ot a permit does not presume <br /> to give oriry to violale or cancel ihe provision oi any other state or local law regula!ing construction or the pertormance ot <br /> cons ct' n.Thal I am a o ' e by the owner4t t ' property to peAorm�he work for which application is made and I comply with the <br /> Sta C tractors Law .2 and 29E.200 C. /�'r/� <br /> � � L.G' . �, � <br /> 08tB � �..�7 L� <br /> S ature o O ne tracWr� ulfioriz�d ge t �� , , .. <br /> �!� /.li�E'� t: Cit1�S <br /> �/� <br />