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_� �, <br /> � _i�/ I <br /> r�ERMIT APPLI�A�iON <br /> CITY OF EVERETT PERNIIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � _�7.-O� <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATtONS ARE ACCEPT�ED FROM 8 AM TO 4 PM <br /> 1 ���� �S�,�' -' � <br /> SITE AD�RESS �/ ����� PARCEL TAX I.D.�I PER T# <br /> 3� V� v"" l�L ' ^ � �-Jl/ V U���� �� � � <br /> LEGA LOT NQ. p��'� BLOCK / TRACT OR SUBDIV1910N N � <br /> DESC. .:� — �U�U ��:'}'- C 4'' t'' <br /> OWNER � � p �ix �, /lD RESS r y 5� � .�CRY I , . 1/1PMONE�CGa_� <br /> � W r! O <br /> �n��c�.���i Vf , _1���`��rv��n�S -3►�C� � �4��1 ��i 3� <br /> TENANT NAME I CONTACT FQR PERMR PHOHE�)� C-� �j� � � <br /> � I n_11�.1,�LG�������� E-AANL MI�S�� Yt'LiYl�l'1 �, <br /> �-l.��C� <br /> �G1�1E. ' 1-hr� Gc:N1S�IcC�IQ✓l� 1 n v <br /> corrtA.ucEr+se x <br /> �Ec���\eC(�-laN�- �C �X �30�- 1�'1c�r�Ul��L LU� �t�a1(� <br /> USE BU�LDING I — HEAT SOURCE COHTRACT PRICE OF WORK <br /> �\l Electricx Gas Other <br /> WORK DESCRIPTION <br /> �;-e;�.� C°u n S�t�'t,�-C�-K b�'� �- S�'�- l y�� �- 3�G <br /> . � ' . _ - � � �-�.- <br /> � C�� ; k��l�� , . .0 - . � � ` L � � �� <br /> PLUMBING � MECHRINICAL <br /> NO. TYPE OF Fl7(TURE OR ITEM NO. TYPE OF FlXTURE OR fTEM <br /> Toilet I I � A/C-air handling units <br /> 9athtub�a Forced air systems <br /> L� Lavato.ry (wash basin) � { � � � Gas piping <br /> � Shower � Water heater <br /> 1 Kitchen sirk 8 disposal � Gas firep�ace <br /> T Dishwasher Gas range <br /> —L Clothes washer I Clothes dryer <br /> _ } ✓Jatar heater � Fange hootl <br /> � Sink(service/bar/rnop/etc.) Exhaust fan <br /> BacMlnw preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountzin Boiler <br /> Floor drain Retrigeration <br /> Grea;e trap Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specrfied herein or no�.The granting of a permit does not presume <br /> I to give authoriry to violate or cancel the provision of any other state or local law regulatina conslruclion or the perform�nce of <br /> construction.That 1 am authorized by the owner of this proFerty to peAorm ihe work for which application is made and I comply with the <br /> State Contractors Law 78.27 RCW and 296200 WAC. <br /> Signature of Ovmer/Contractor/Authorizecl Agent Date <br /> 1 <br /> � � <br />, - <br />