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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-2��7-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 1 I �-3--D 8 <br /> SITE ADDRESS � AARCEI TAX I.D.# PERMIT M <br /> �o - 3�� �.2 �,�r�� PoB� � �rx�l <br /> LEGAL �O�Np. BLOCK TRAGT OR SUBDIVISION# <br /> DESC. �� ` f� <br /> OWNER ADDRESS CITY2IF PHONE <br /> �- � ,�o � �.GC �9.�r ����f �G �?t�6�C'sa�'j. <br /> TENANT NAM CONTA�CJT FOR PERMIT PHONE <br /> CQ -�� "� 7(.�/ v E-InAIL <br /> / ��i�Cl} � ! C, �1����j'�'�)�� A p (��,J [` <br /> b �J <br /> CONTR.LICENSE#C�i�,�l� /J 'Y'X��<rJ(�O D C�X ..?ZJ 1 _� ;�✓�9a�- / ��0.(lJ 2��/`/ <br /> USE OFBUt�_DING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I ,,+, (� ,y� <br /> � ��•� 1�G //� �,�-��i I �-����� _Electric _Gas_Other <br /> �% <br /> WORK UESCRIPTION Ji/ /� , � <br /> I� � i'��jll/�f�� O �G .�����P� <br /> �l <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TIiRE OR ITEM <br /> Toilet A/C—air handling unils <br /> Balhlub Forced air s��slems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> -� Kilchen sink&-diepeaai Gas fireplace <br /> '�,� Dishwasher _ Gas range <br /> Clulhes washer Cbthes dryer <br /> Water heater Ran�e hood <br /> Sink(service/��ar/mop/etc.) Exhaust fan <br /> Backflow preventor Heat pump <br /> Urinal � Unit hbater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> Roof drains Other _ <br /> Other _ <br /> CITY 1?F 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 tr�e and:.orrEct. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied wilh•nhether specified harein or not.The grarling of a permit does not presume <br /> lo give aulhority to violale or cancel lhe provision ot any olher stale or tocal law regulating consiiuction or the performance of <br /> conslruction.That I am authorized by the uwner of this property tc perform the work(or wtiich applicatian is made and I comply with the <br /> State Conlraclo/rs Law 18.27 P,C�nd 296.'L00 WAC. <br /> /i��/ �f�.������Il /�' J J l.� <br /> Signature o(OwnedConlractodAuthorized Agenl Dato <br />