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� � <br /> ,t <br /> � PERMIT APPLICATION <br /> ! CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—ww�.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE ADDRESS Q�Q9 � PARCEL TAX I.D.# PERMIT# <br /> ID3lS T1t ve s6 ST� !lo - �� -�L <br /> IGGAL LOT NO. 6LOCK TRACT " <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �f; Ce/IceAJ !Pi¢�Y I �M SDw�i.�✓ y1S'`��ll'�'Y�/ <br /> CONTRACTOR ADDRESS CITYI2IP PF{ONE <br /> Rec��,��ce �P. grGs ?ay�,��� SE. O�esTe.✓ <br /> 9�oso <br /> CONTR.LICENSF.# z o C-68 Z-�6 36 <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other <br />� WORK DESCRIPTION <br /> �Afl Pen�oa�r sp�i�✓Itler�s r �x,� r;NJ sy�sr��,. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TIIRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—airhandlingunits <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Waterheater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> _ Clolhes washer Clothes dryer <br /> _ Laundry tray � Range hood <br /> _ Sink(service/barlmopletc.) � Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br />� Floordrain Refrigeration <br /> _ Grease trap Woodstove <br />� _ Roof drains Other <br /> I _ Other _ <br /> i — — — <br /> � <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and know ihe same to be true and correcL All provisions of laws and <br /> ordinaces governin�this type of work will be complied with whether specifed herein or nol The grenting of a permit does noi presume <br /> to give aulhority ic violale or cancel lhe provision of ar,y o!her slate or local law regulating consiruction or the pertormance of <br /> construction.That I am authorized try the owner of this property to pedorm ihe work for which application is made and I wmply with the <br /> State Contr tors L�w 1827 RCW and 296.200 WAC. <br /> �1 AII <br /> rb�IlX... z-�o-D b <br /> Signature o wnedContractor/Authonzed Agent Date <br />