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� r <br /> PERII�IT APPLICATION <br /> CITY OF EVERETT PERM4T 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 a `���-�� <br /> SITE ADDRESS pARCEL TAX I.D.Jf PERMIT# <br /> rz�z� �q,-H a�� s��. �,�, �o� ��-a - �a�- <br /> LEGAL LOT N0. BLOCK TRACT OR SUBCIVISION N <br /> DESC. <br /> OWNEFi ADDRESS � CI'Y21P PHOM� <br /> V�u��uz� T.y %r�;,�.r, � �.�.K, <br /> TENANT NAME I CONTACT FOR PERMIT PNONE <br /> IJ �4Z5) Z52-311y <br /> ��'.l�t.�L'E I'�1:��/kc� E•MAIL KQKSa lGC'�.a�S. .'IC�iQ.CO h <br /> ON RA R ADDRE y/z p� <br /> l-.Ul.i2(cRL-7�� ��ivtiZ ���'vkr � �C 2�2� �'�+c���i. cu�� 4"G7,�:� �4) Z5Z-311� <br /> CONTR.LICENSE# <br /> � Ut 2655 oZzcT <br /> U£E OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��� � _Elec�ric �Gas_Olher � 3Q �� Q� <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> ____ Toilot A/C—air handling units <br /> _ Balh�ub � Forced air systoms <br /> _ Lavatory(wash basin) j Gas piping <br /> __ Showor Waterheater <br /> _ Kilchon sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clolhes washer Clothes dryer <br /> _ Watcr healor Range hood <br /> __ Sink(servico/badmop/c�c.) Exhaust tan <br /> ___ Backflow preventer Heat pump ' <br /> _ Urinal Unit heater <br /> __ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> ____ Rool drains Other <br /> Othcr — <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know ihe same to be true and correcl. All provisions o(laws and <br /> ordinaces goveming this type ol work�vill bo complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give aulhonly to violale o��c�ncol�he provision of any other state or local law regulating constmction or the pedormance ot <br /> consiruction.Thal I am uthorized by Ihu owner ol this property to perform the work for which application is made and I comply with�he <br /> State Co�tr tors Law�@.�7 R¢W and'<96.200 WAC. <br /> ��'' Z— l`6— I c� <br /> Signatur ol OwnodContractor/Authorizod Agent Date <br /> I <br />