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' � ( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425•257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � I _veacc� rev�n e PEFMITI# <br /> � �� �.80.��9�Wex�y� S ��v.� - 00/ <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# Cl{1C,1 F C'�S�V Z'�,�J <br /> DESC. <br /> OWPlER ADDRESS CITY2IP PHONE <br /> TENANTNAME CONTACTFORPERMIT (,'('Jng,C:�{ PHONE_ �/_ D� [ I <br /> �/ ' ' In -ry� r ` f�F iC� <br /> '[ tth �� i i`�c- / � � � N��S � e�aar�� cy <br /> �c.�T�ol� �l� 5zc�a iZZ.`�'s�E Z�RS`� � � �S ��� � <br /> CONTR.LICENSE# C U��E�qg�M U <br /> USE OF BU�LDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> �f'r��� _Electric _Gas_Other ,`vv�.% <br /> WORK DESCR�PTION ( ��G` I��u�Z �F ��LC.. S� <br /> ,=orz a� �K � -, s�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A�C—air handling unils <br /> Bathtub Force air systems <br /> Lavatory(wash b,asin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/elc.) _ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal Uni�healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Rool drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify ihat I have read and examined this a pplication and know ihe same to be true and correct. All provisions of laws and <br /> ordir�aces goveming this rype of work will be complied with whether specified herein or wt.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision ol any other state or local law regulating construction or the performance o( <br /> ns uction.That I am autYiorized by Ihe owner ot this properry to perform the work for which applicalion is made and I comp�y with the <br /> Sta�e mract rs�aw .27 CW and 296.200�NAC. <br /> �—�—Og <br /> SignaWre ol OwnedConlractodAuthonzed Agent Date <br /> 'IL <br />