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t <br /> PERMIT APPLICATION <br /> CITY OF EVERET7 PERMIT SERVECES <br /> 3200 CEDAR STREET, EVERETT, 1h'A 98201 <br /> 425-257-8810— FAX 425-257-6857 —H^v✓w.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � Z �, �7 �� <br /> SITE ADDRE5S .� � PARCEL TAX I.D.# P RMIT# <br /> /o3T5 IQ+" tiv� sr iC� o lo n ' c� o ( o � o� � �. ' �I� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS i CITY2IP PHONE <br /> ��� � CLC �c� BO� �2of3 I ,y/(,C CP,EF-IC WA <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �N,f� C �C SA/`�I � ���-�/� � L 1�25 � �33��y\\ <br /> CONTRACTOR AD�RESS CITY2IP PHONE <br /> CONTR.LICENSE# �U�` <br /> US�OF BUILDING HEAT SOURCE I CONTFtACT PRICE OF WORK <br /> �/-- 2 V v J <br /> G rF�C � S�A�E _Electric�Gas_Other �.� <br /> WORK DESCRIPTION <br /> ���,�-r�-vG D I v 1 �� r�t/G, L✓Q <.� s. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM ' NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ NC—airhandlingunits <br /> Balhtub Farced air systems <br /> Lavatory(wash basin) _ Gas pi�ing <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(service/b, op/etc.) _ Exhaustfan <br /> Backflow preven,.:r _ Heat pump <br /> Urinal _ Unil heater <br /> Drinking Fountain _ Boiler <br /> Floordrain _ Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains _ Olher_ <br /> Other — — <br /> _I _ — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritiy that I have read and examined this application and know the same to be Vue and correct. /111 provislons of Iaws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granGng of a pertnit does not piesume <br /> to give authority to violale or cancel the provision of any other slate or local law reguladng consWction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which applic�don is made and I comply with the <br /> State C��ors La�.,'�lRv�nd 296.200 WAC. /2_`2 �� <br /> - J L <br /> Signature of Ow r/ConlractodAuthonzed Agent Date �/Z <br />