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i � <br /> PERMIT APPLICATION <br /> CITY �F EVERETT PERMIT SE�VICES <br /> 3200 CEDAR STREET, EVERET"f, N/A 98201 <br /> 425-257-8810– FAX 425-257-8857–www.2verettwa.org <br /> APP..ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PIVI �a ._.Qrj`� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI'9: <br /> ' (�� ����I�. - <br /> 1 �-�3 l`i�� ��ve Sc i� � �c��a cd;a ��o�cac� ---�I I <br /> LEGAL LOT NO. BLOCK TRACT OF)SUBDIVISION# <br /> DESC. <br /> I <br /> OWNER ADDRESS CITY2IP PHC�NE c`��_ Q�.�.— � <br /> �;�`2a� �� v.rv�c;.�: i b°�'3-`� ���i��` t�e ��-_� fs �v''"'�- ��(o� <br /> TENANTNAME CONTACTFORPERMIT PHONEaO '����� <br /> � ��Pw�%— I��l��u� ��Umt��RJ E-MNL _ <br /> CONTRACTOH�' "��RESS GTYRIP PHONE <br /> �rohu.��S�� cr.:�,-1�t S�iCS u>U� ��l�Ci�;, f� � <br /> L� (, ���� --�b 3 � ��i <br /> CONTR.LICENSE#���^�C�,v ��1.���Q �.�'.`� V � � <br /> USE OF BUILDlNG HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,/@lectric Gas Other � �L'L�� <br /> WORK DESCRIPTION <br /> ) <br /> "1c�s��:�� � ���ac�l��n ��t�,�,�.� {\,��. t i i„��� iS��ac;cw IJ �'� L <br /> ��ti.K ��� c�u�]lc� c,v� �.n�} � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air syste^�s <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas firaplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water hea:er Range hood <br /> _ Sink(sercice/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer � Heat pump <br /> Urinal Unit heater <br /> � _ Drinking Fountain Boiler <br /> Floor arain Fietrigeration <br /> Grease trap Woodstove <br /> Roof drairs Other <br /> Other -- <br /> CITV OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby centily ihat I have read and examined ihis applicatio�and know the same ic be tr�e and correct. All provisions o(laws and <br /> ordin�ces goveming this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any other state or local law regulating construction or the pedormance of <br /> construction.That I am authorized by the owner of Ihis property to peAorm the work(or which application is made and i c_mply with the i <br /> Statc Con�ractors Law 18.27 RCW and 296200 WnC. ' <br /> _se.c�w�s-- —11�.1� �� ���G� �U� <br /> Signature ol OwnedCon�rac od ulhoNzeU" genl Date <br />