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i� <br /> PERMIT .�PPLICATI4N <br /> CITY OF E��ERETT PERMIT SERYICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810– FAX 425-257-8857–www.everettwa.org <br /> �� I ;> <br /> � ^/��, APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �l���,'_.�y��� <br /> SITE ADDRESS p21� . . PARCEL TAX I.D.# PERMIT# <br /> ��� � � ���s>r- aoA�3�igB���ao �J�2 -O/Z- <br /> LEGAI LOT NO. BLOCK TRACT <br /> oesc.� /7v�lB 4'86.�-0 6/�G-�C-�T ��T_' <br /> OWNER ADDRE55 CI^IZIP PHONE <br /> (r' � , � � , �.r a �v � F� `. ' 1 f Y.:�,3 i� -3`r� r <br /> nac�h :l. �l1ar��, • `lf> > ; �� ,.-�.�r �a �, <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � e �,,;,,� ,� l�� ?j 5�.��� `� <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> 1 <br /> CONTR.LICENSE fl �,` <br /> sI�,.J <br /> � . ��GJ/�.L/ <br /> USE OF BUILDING HEAT SOURCE J�C ONTRACT PRICE OF WORK <br /> _�� 'S�� _Eledric '�Gas_Olher " " 3�� Z'3 �� �./,s-F <br /> WORK DESCRIPTION � <br /> �OiVs w� �t/c�w bu���x ',�� 7��. `��=�' <li� r:- �� <br /> _ -1 l�- �,�,n� � <br /> PLUMBING MEGHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> c ' Toilet A/C-air har,dling units <br /> ��- '/ Bathtub � Forced air systems <br /> t'� Lavatory(wash basin) � Gas piping <br /> (�� Shower Water healer <br /> Kitchen;ink 8 disposal ?- Gas fireplace <br /> � Dishwasher �Y Gas ranqe <br /> Cblhes washer 'Y" Cblhes dryer <br /> � Laundry tray � Range hood <br /> Sink(service/bar/mop/elc.) ,9� �xhaust fan <br /> � Backflo.v preven�er _ hleal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain ftefngerati�n <br /> Grease trap _ Woodslove <br /> Roof drains _ Olher_ <br /> ;� Other ��S��R Gf"'j�LlQp — <br /> � • <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify that I have read and examined ihis applir.ation and know the same to t�e Irue and correct. All provisions of laws and <br /> ordinaces goveming ihis type of work will be complied with whether specified herein ar not.The granling of a permit does no�presume <br /> to give authority to violate or cancel the provision of any other state or local law regulatiny consiruction or the pedormance of <br /> construction.That I am aulhorized by lhe owner of lhis property lo peAortn lhe work for which application is made and I comply with ihe <br /> State Contractors La�+18.27 RCW and 296.200 WAC. <br /> �r � <br /> ��/��i��i �� ,,:'j :�,��:. ( 1�j���� �;i <br /> Signature of Own dContractor/Aalhonzed Agent ' le <br /> � - -- _.— l .,/ �� <br />