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' <br /> r � <br /> . i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVtCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-251-8857—www.everettwa.org ('z —�—/� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 pM P(�/Z --R73 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI # <br /> ' ,� U C> �- 3 /'�-- U.J <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIYISION il <br /> DESC. <br /> OVYIlER ADDRE33 CITY2IP PHONE <br /> ��C.7-f' /Z l� ��'/1-��'1��� � 'L7��� �` � � ;4 S J <br /> TENANT NAME CONTACT FOR PERMIT PHONE 3� U L � ( � DU S <br /> I C/—` L> V(� ��'"" �%I' L C L" L�—I S �.,.� I)V C. C.-c'_x � E-MAIL S c.✓ITC�% �vinlK dN i <br /> iz ���w��,���� , ?� L <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eledric _Gas_Other / S� �j S C <br /> WORK DESCRIPTION <br /> �� �. L il�� { j1;L L . <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FIXTURE OR ITE1A NO. TYPE OF FI%TURE OR ITEM <br /> ,� Toilet _ P✓C—air handling unils <br /> Bathtub Forced air systoms <br /> � Lavatury(wash basin) _ Gas piping <br /> � Shower _ Water heater <br /> _ Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> � Water healer _ Range hood <br /> Sink(servicelbar/mop/eic.) _ Exhaust fan <br /> Backflow preventer __ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease irap _ Woodslove <br /> Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE 13 3105 <br /> I hereby certify ihat I have read and examined ihis applicalion and know ihe same to be true and correcl. All provisions of laws and <br /> ordinances governing this type of work will be complied wilh whether specified herein or not The granting of a permit dces not presume <br /> to give authority lo vidate or cancel the provision of any other state or local law regulaling wnstruction or the performance of <br /> construclion.That I am authorized by the owner of lhis property to peRom the work forwhich application is made and I comply with the <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> i � , � l °Z - � /D <br /> Signature o�Owned ontract r/Authorized Agent Date <br />