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PtRMIT 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 � , .�}_Q Jr <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 1-�'' <br /> � <br /> SITE ADDRESS �/ r �„ � PARCEL T=1.D.#_ PERMIT# — <br /> / /� .��1"� �� /btq .� -D�s <br /> LEGAL LOT NO. BLOCK TRACT .� �' (J,�j G �{ —(3 Z <br /> DESC. <br /> OCWNER ADDRESS CITYIZIP PHONE <br /> \LL�Wi�2� �6L �Z ��/ � L. <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> X �}����-e (�nclCS�rJM �/�S= 30� - 5.27 ( <br /> C TNO RACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# �/ � <br /> �J� n �' .a <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric Gas_Other <br /> WORK DESCRIPTION <br /> j�'�od� �i�..� <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air ayslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas ranye <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hocd <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease Irap _ Woodstove <br /> Roof dreins Other <br /> Other ,___ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritif:lhat I have read and examined ihis application and know the same lo be irue and correct. All provisions of laws and <br /> ordinaces gode!ning lhis rype of work will be complied with whelher specified herein or noL The granting of a permit does nol presume <br /> lo give authoril��to violale or cancel the provision of any olher state or local law regulaling construction or the performance of <br /> conslruction.That I am authorized by lhe owner of this property to perform the work for which applicalion is made and I comply with the <br /> State Cont ct rs Law 18.27 RCW and 296.200�NAC. <br /> � - �, 9-i9 -�, � <br /> S' at re f OwnedConlractodAulhorized Agent Date <br />