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r <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �W '1 blv -3 � <br /> SRE ADDRESS � �A C L TA D If � PERMR If <br /> �sa.s- s�4�sf��-.,1'� .FZ ,a�.#o�e��I�j6Z90f0.�'6G O�O - C�D <br /> DESC. LOT.N+y0. BLOCK �R/ �T OR SUB�ISION N ., � G3 �"-�� <br /> / V VL'rt� <br /> OWNER ADDRESS CITY2IP PMONE <br /> C4G' 'l•r✓F�'-�'��s No�f�iwF�f[LC �ZS '��%�C�' <br /> TENANT NAME CONTACT FOR PERMIT PHONE �j'thiJ,sl�,jr <br /> I QA/I10�/1���.�.'fT e�a��GAl��i�'S� � „�j�,i <br /> �l�f►fi�.,�l�o�� izi�z3ia' A�ix�;Syel�Pi�Oi��s' .�•s��•�/Q�'zX� r���"/ <br /> CONTH.UCENSE Jt GSFE3H�-���rn/ <br /> USE OF BUILDINa HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � f�� �/ "' <br /> f�M/Q ��/Y1i�/t�'S'jR"c�'�� _Eleciric �Gas_Other Y`�r���� <br /> n <br /> WORK DESCRIPTION <br /> ��% <br /> �(,�E,py �O�r.��ur7/N/f <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlX7URE OR rtEM NO. TYPE OF FlXTURE OR REM <br /> Toilet A/C—air handling units <br /> �.L Bathtub � Forced air systems <br /> � Lavatory(wash basin) �f Gas piping <br /> Shower � Water heater <br /> / K(tchen sink&disposal Z Gas fireplace <br /> � Dishwasher Z Gas range <br /> � Clothes washer � Ctothes dryer <br /> L Water heater � Hange hood <br /> � Sink(service/bar/mopletc.) _�, Exhaust fan <br /> Backtlow preventer __ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> Floordrain � Relrigeration <br /> Grease trap _ Woodstove <br /> Roof drains __ Other <br /> Other — <br /> CITY 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. Atl provisions of laws and <br /> ordinaces governing this type of work will be r,omplied wilh whether specified herein or not.The granting of a pertnit dces not presume <br /> to give hority to violate or cancel the provision ot any ather state or local law regulating consiructian or the performance of <br /> cons cC n.That I am a o ' e by the owner4f t ' property to perform ihe work for which application is made and I comply with the <br /> Sta C tractors Law 2 and 296.200 C. <br /> l���7 <br /> S ature o O ne t�acW ut onzed ge t Date <br /> ,��' �x��� E ��s �Iz <br />