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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4'L5-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /O�a6—i� <br /> SITE ADDRESS �1IEt8t11n7A PARCEL TAX I.D.# PERMIT# l � <br /> l2�-z$ I �" A�sE 9$ws .l if/� �> <br /> LEGAL LOT NO. BLOCK TRACT OR SUB']IVISION p <br /> DES". <br /> OWNER ADDRESS CITYIZIP HONE <br /> Q� '�j"'.,, "� q82� �25 3�-9 ?�Yy <br /> IJUILDQRS -+-^�`�5�� GRPI.tP �,LG I2�'LS' 19 A1�� `�102 <br /> TENANT NAME CONTACT FOR PERMIT PHONE NZS �IG yl y6 <br /> W��N W�M�,�- G�� I s�- �� E�,�@W�M��.�� <br /> C NTRACTO n /�_ � ADDRES CITYf21 PH NE <br /> �Act�L tttUan�c� (,t�s�cnoN 112N S��� � � 2p(o f$3$ 8'I$i <br /> CONTR.�.ICENSE� \ �jE',�}'rf� (,�- qglOq <br /> r�C i ��C �1�-� �'Y �f>>/,�, , <br /> U5E JF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 0..,1�,���-r �N\L���^,� I _Electric _Gas_Olher I � `�'�i ��� <br /> ,�.,C <br /> WORK DESCRIPTION <br /> G • �,�q G �p (LO S�G S� -e <br /> 2 Fr,00es o� o�-F��im,�-f- � �� �� 5 <br /> I�u/���ueh� ad!m in rt is��b� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � <br /> AIC-air handling unils <br /> � Toilel MELH- <br /> - � ���Bathlub , � Forced air systems E�'�� ��. <br /> 2� lavatory(wash basin) � Gas piping <br /> 1 Shower �� � Water heater On1 CiOP.4-'� �l'Ei. <br /> � Kilchen sink&disposal - � -Gas fireplace <br /> Dishwasher G�s range <br /> X Clolhes washer ���� Clothes dryer <br /> k Waterheater �Range hood <br /> �C Sink(servicelbarlmopletc.) �.,;_Exhaust fan <br /> I � Backflow preventer � HBal�pUmp <br /> �.- �-Urinai'� Unit hea er <br /> I � Boiler <br /> X Drinking�;Founlain �. e(�iger lion <br /> �_ Floordrain� — �.�� 10Ve <br /> � Grease trap Other <br /> Rooi drains — . <br /> � Olher / \ _ — -� _ <br /> �� — <br /> I <br /> il CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> III hereby certi(y that I have read and examined ihis application and know lhe same lo be true and correct. All provisions of laws and <br /> ordinances goveming Ihis rype of work�vill be complied with whether specified herein or noL The granling o(a permit does not presume <br /> Ito give authoriry lo violale or cancel lhe provision of any other stale or local law regulating construction or�he per(ormance ot <br /> cons�ruction. That I am a horized by lhe owner of lhis property to peAorm the work for which application is made and I comply with lhe <br /> State Confr ctors Law 18�] and 2'J6200 WAC. <br /> %� 10�18�In <br /> ISig a e of Owner/ n(rac odAuthorized Agent �a� I/� <br /> I _ <br /> �- <br />