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—� <br /> PERMIT APPLtCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> <}25-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS CV�AE I j A 't� PARCEL TAX I.D.# PERMIT# <br /> raor � lKrf� �+vE s� < <r����p, � iar>(��cc�2 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION ll <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> S� r��au�s I nr/N,Nh Sn�or.� <br /> TENANT NAME CONTACT POR PERMIT PHONE (�'L S -3 2 �'5�,}2 y y <br /> 11 L/� �1 0 � p r.��./ (' . I 3`/ c� s E-MAIL A �Q UGS COA'/MC� <br /> R T ADDRE ZP {)D MG��/✓� <br /> GONTR.LICENSE# �� L A C C � � � Q �� <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric _Gas_Other 5 ���, ^ <br /> WORK DESCR!PTION (' <br /> � �}til. ��;�L�o�- � � I 3/3 (, -� �� <br /> �LA✓ <br /> � bNhnii u� 0'{E <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handiing units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Ki�chen sinlc&disposal Gas fireplace <br /> Dishwasher _ Gas renge <br /> � Clo�hes washer _ Clothes dryer <br /> Water healer Range hood <br /> Sink (service/bar/mop/etc) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease irap Woodslove <br /> Roof drains Other <br /> = Other __ I — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify lhat I have read and examined this application and know tha same to be true and corred. .411 provisians ot laws and <br /> ordinances governing this type of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> lo give authority to viol e or canc ihe provision of any other state or local Iaw regulating construction or the performance of <br /> construction.That I am a orize by the owner of this propeAy to perform ihe work for which application is made and I wmply with the <br /> Sta�e Contractors,l.aw 1 '2 and 296.200 WAG ^ <br /> Signature of OwnedCont /Au orized Agent Dale' �I� <br /> �� <br />