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PERMIT APPLICATION ' Il ` o� <br /> CITY OF EVERETT PERMIT SERVICES �IN �� �'�3 I <br /> 3200 CEDAR STREET, EVERETT,WA 98201 r� /��J <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org / � r <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (�_ o1—Q� <br /> 31TE ADDRESS PARCEL TAX I.D.M P RM li <br /> 5'j�L 7 S -�I-V �� W ��,�;c r a,5'OC✓_��,C�Lx!,�-a�_) l 5 " (�1J <br /> LEGA LOT NO. BLOCK TP.ACT OR SUBDIVI N , "� <br /> DESC. �j� �.�r✓'�t'_v�--��,� ���5 uV, .( <br /> OWNEN ADDRESS CfTY21P'�Lc,�jPM E yS <br /> ;c_�,��.,`J�� A- �Vv. �c�� 5��1 25 A-v� vV EvcJ���- 4�f �2�Z_._ <br /> � <br /> TENANT NAME CONTACT FOR PERMIT PHOfiE � <br /> /�}_� L �(/}-i_.!E !"�1'U�Gj,CYa7�/1")a.f�• C'c7 <br /> E�#AAIL O <br /> - ���-�_ �=�f.�u['..�tl Z�!/ ,54-��L Z5 /N_�c, V�/ C�c�.'v, `i%ZD'� ,`,'�l L�L <br /> co�.uceNse r <br /> J � <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Cl S/��� Cf L{�� I _Electric '�Gas_Other i Z7 �'- �����—�-�� <br /> WORK DESCRIPT'ION "�,� <br /> L��t��rn��,�-,�f�rn�'� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OP FlXTI,RE OR ITEM NO. TYPE OF FU(TURE OR I7EA1 <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> _ Shower Watar heater <br /> Kitchen sink&disposal Z Gas firaplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dq er <br /> Water heater Ranpe hoad <br /> I Sink(servicelb�r/mopletcJ _ Exhauslian <br /> Backflow preventer _ Heat purtip <br /> Urinal Unit heater <br /> Drinking Fowitain _ Boiler <br /> Floor drain Retrigeration <br /> Grease trap _ Woodsrove <br /> Rool drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> I hereby ceritify that I have reaA 3nd examinod this application and know the sarne to be true and correct. Ail provisions of laws and <br /> ordinaces governing this type ot work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law repulating construcfion or the performance of <br /> construction.That I am authorized by the owner of this property to peAorm the work for which application is made and I comply with the <br /> State Cpntracrors Law 18.27 RCW and 296.200 WAC. , <br /> � S/ b <br /> �ji/L �__. ii l � <br /> r SignaWra o( or/ ontractor/Authonzed Agent Dale �I I <br /> Z <br /> jITl ��l <br />