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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT P�RM1T SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 42��-257-8810— FAX 425-257-8857•-tn�ww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � I b� '�� <br /> SITE ADDRESS � PARCEL AX I.D.p PERMIT N <br /> /X��' ���.-,��'f'f N� �Z 40�30i�vo/ 9'�25'0 5'O.��Goo 7171�, ' D.S <br /> LEGA LOT NO. BLOCK ����T OR SUB�ISION M ., � C 3 �"_M� <br /> DESC. 'rL �NC,�u 4V <br /> OWNER ADDRESS CITY2IP PHONE <br /> C¢d�.l.r✓Fy�'-�n;� No�1�iwE�f[dL' 'fZ-�=�•�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE �lj'�I,S�J� <br /> I DANn�fl9�cL�c�,'T/ E1ANL�Ci/•�/l�3� �J' � <br /> ���E,�f�l�o�»r� iz�z3fa� ��x�;sre�P.�10%�s-�r�s����/Q�zX� rczssbs�s"/ <br /> CONTR.UCENSE N `s`��-�J��ly�I�G� <br /> /! fn 7(/ <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> r�� � ��' O <br /> ��/�r-�Q�q��/�E+fyL�cC'�C� _Electric �( Gas_Other � i � G <br /> WORK DESCRIPTION <br /> ��7 <br /> ��rr�,y CO�u'/`/�c(C7/N// <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURF OR ITEM NO. TYPE OF flXTURE OR ITEM <br /> � Toilet A/C—air handling units <br /> 2 (Z Bathtub � Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> Shower � Water heater <br /> / Kitchen sink&disposal Z� Gos lireplace <br /> � Dishwasher Gas range <br /> � Clothes washer � Clothes dryer <br /> � Water heater � Range hood <br /> � Sink(service/badmop/etc.) ��_ Exhaust fan <br /> Backfiow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain Boiler <br /> Floor drain � Relrigeration <br /> Grease trap _ Woodstove <br /> Roof drains __ Other_ <br /> Other — <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specitied herein or not.The granting o1 a permit c:oes not presume <br /> to give ority to violate or cancel the provision ol any other state or local law regulating construction or the perlc.mance of <br /> cons ct' n.That I am a o' e by the o�vneraf t ' propeAy to perform ihe work for which application is ma�e and I comply wilh the <br /> Sta C tractors Law .2 and 296200 C. <br /> l. z.�/07 <br /> S ature o ne tiacto u� onzed ge t Da�e �/ <br /> �� L�GF� E- /11E'.S Z <br />