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� �r �.l�l�S i <br /> �;- ����;� � PtRMIT APPLiCATIUN <br /> �.���w ,—�z P,o�GS-c�36 CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> �L)3 � S APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PNi <br /> S1ITE ADDRESS /] c� PARCEL TAX I.D.# PER!MJIT# / <br /> �1"��SL ? ��'^ �\�'� �-?� � `S�lSSCCGc:0�1cf; -0�'15SC�cOoc�Oo � / �/ ��V' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE�/ '// '•� <br /> t7 W <br /> s� ���� ���� r�����, ��� ;� ��� z��� <br /> TENANT NAME CONTACT FOR PERMIT PHONE Z� .S'� 1 -3SS'�— <br /> � ���I ' �� a I L�IMO(1� P.^ E•MA�'`'l�� l.�('S 1 I <br /> C RACTOR qODRESS CITYIZIP PHONE a <br /> t-i 1�T le..��Se F i� ������c"_ l�� �4 -��ir���rr ��f` go-Ct,�l ( ti��, �Izr 45'i C�� � Q. <br /> CONTR.LICF.NSE# <br /> t`i 1�-s7 cl-�c}tS 1 R-� r <br /> USE 0 UILDING HEAT SOURCE CONTRACT PRICE OF WORK n <br /> C��� �� I _Eleclric _Gas_Other I �,��� ,� � <br /> WORK DESCRIPTION � P <br /> /�d� (J n��✓ In,:� c�S o � � ex�,sfi �1uq �c o <br /> V T <br /> e <br /> c <br /> It <br /> PLI�MBING MECHANICAL � <br /> i ° <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM j Y� <br /> _ Toilet A/C-air handling unils � <br /> _ Bathtub Forced air systems �- <br /> _ Lavatory(wash basin) Gas piping � <br /> Shower Waler healer � <br /> — C <br /> _ Kitchen sink 8 disposal _ Gas(iraplace � <br /> _ Dislnvasher _ Gas range 5 <br /> _ ClMhes washer Clothes dryer T <br /> _ Water healcr Range hood <br /> _ Sink(service/badmop/elc.) Exhausl fan � <br /> _ Backllow preventer Heat um � <br /> P P <br /> _ Urinal Unil healer � <br /> _ Drinkiny Fountain Boiler <br /> _ Floordrain Refrigeretion <br /> _ Grease lrap Woodstov L <br /> _ Roof drains Olher �( n+:5�� �1 `\'L� <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined this application and know the same to be Irue and correcl All provisions of laws anu <br /> ordinaces goveming lhis rype o(work will be complied with whether specified herein or noL The granting of a pennit does not presume <br /> to give aulhority toy iolate or cancel ihe provision of any other state or local law regulating conslruction or the perfonnance of <br /> construclion.Th�YI am authorized by the owner of this property to pedorm the work for which applicalion is made and I comply with ihe <br /> Stale Contrac efs L w 18.27 R and 296.2U0 WAC. <br /> __-�I�i���� � /��-••'__ / �� ��� �� <br /> Sign re of Owne ontractorn{uthonzed Agenl Date <br /> � <br />