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. <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMII SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED PROM 8 AM TO 4 PM 7 � S—O-p <br /> SITE ADDRESS � PARCEL TAJ(I.D.# PER IT# <br /> a - 3 �' �o�9oS- �-o�� -o��o r �O olo - co <br /> LEGA LOT NO. BLOCK TRACT q p L �/7 <br /> DESC. � �k-f��Cl� ( /\SC � i"€.�� •� <br /> OWNER ADDR S ITY21P PHONE <br /> ('��-, �t�l�.- �+ rnG.+��� Ge ,�. _ . �ars 6�,-� S.,a����ti <br /> TENANT NAME CONTACT FOR P MIT PHONE �q <br /> � � Q � �� � �r��-33 �a <br /> CONTRACTOR �"J'�(y` r�-_1_.Z /f s� /E�� aZ��O ITY21��oml N�� �I <br /> Y� l l L+lN <br /> COhTR.LICENSE# \ � Frr. �_V_OSJ�^ jL LI—I�I_v� <br /> tJ 1` T '� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � �Electric _Gas_Other <br /> WORK DES IPTION <br /> ��.�,Pc� f✓.��� ���---�'�'�`�- <br /> �o �-� o <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> Toilef A/C—air handling unils <br /> Bathlub Farced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> _ Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Water heater Rangs Mod <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain f Refrigeration <br /> _ Grease trap Woodstov�� <br /> Roof drains Other <br /> Other�.xQ _ _ <br /> CITY OF EVERETT LOCAL SALES TAl(CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis applicalion and know lhe same to be true and cortect. Ali provisions of laws and <br /> ordinaces governing lhis lype of work will be complied wilh whelher specified herein or not.The granling of a permit does not presume <br /> to give authorily to violate or cancel the provision of any other state or local law regulatlng construcUon or the performance of <br /> construction.That I am aulhorized by the owner of thi property lo perform lhe work for which application is made and I comply with the <br /> Slate Conl clors Law 18.27 RC a 6. W <br /> ✓' � a d � <br /> �n ure of ner ont ctodA`ut n Agenl Dat I/� <br /> J <br />