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1�-�-(' �i t: �!�t'i C'C'C �� J " t lG`�� <br /> r e <br /> PERMIT APPLICATION <br /> CITI( OF EV�RETT PERMIT S�RVIC�S <br /> 3200 CEDAR STHEET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCBPTED FROM 8 AM TO 4 PM ��� � ,-;� - l�!' <br /> SITE AODRE r PARCEL TAX I.D.X P�AMI'f fl <br /> 0 i� 4'� �<� o a 3 �-1-C� i �C ' J�6 � � <br /> LEGA l0T NO. BLOCK TRACT OR 9UBdVI310N• . <br /> oesc. -- "�U� �7�� ��> '�cs..,��,0 1 n-�-e.�C�., <br /> OWNEfl �U �� 1 3C � YVIQY� � -ry ` :3"(v CRY21P PHdNE <br /> .�n„cvc�-I-��l-� Tnv�s�l-m�n�S , 1��, 3�1��-�5�-5�3� <br /> TENANT NAME I CONTACT FOR P RMR PHONE�—� 1�S I <br /> ��eCA.�'1Gl,�C�Sf.'/1G�'-�- E�al��w r�j n,SC ��1 <br /> � , <br /> � r� <br /> =C�1C �-�-�'�J �nS�r1.t ' cs'l,l�'lC� � <br /> ��:1E��c' �iu-a.,�l�� �O �c�c ►3c�-I- i'1'Y�r�iS�I�� ' - In )I� �l �6�--ZC� <br /> USE UILDIkG HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � � _Electric �Gas_Other <br /> WORK DESCRIPTION <br /> �7�'� 7JP�/.1., �'1�J'���-- �C'�-'� �'1 I��� I �� �.'� I � <br /> �1<�cAC1Y ('��(`�fZ-��. � �i G:� - C-J�" L-'�` � �,��7 <br /> PLUFABING MECHANICAL <br /> d0. TYPE OF FlXTURE OR ITEM NO. TYPE OF FDCTURE OR fTEM <br /> � Toilet A/C–air handling units <br /> .� Bathtub 1 Forced air systems <br /> � Lavatory (wash basin) � Gas piping <br /> � Shower _L, Water healer <br /> 1 Kilchen sink 8 disposal .� Gas fireplace <br /> � Dishwasher Gas range <br /> 1 Clothes washer i Clo�hes dryer <br /> � Water heater ! Ran�e hocd <br /> Sink(service/bar/mop/etc.) �� Exhausl fan <br /> Backfiow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <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 cortect. All provisions of laws and <br /> ordinaces goveming this lype o(work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel ihe provision of any other state or Ixal law regulating construction or the performance of <br /> construction.That I am authorized by�he owner of lhis property to perform the work for wnich applicatior is made and I comply wi�h the <br /> State Contractors Law 78.27 RC�V and 295.200 WAC. <br /> ��%�;/;::� <br /> Signaturs of Owner/ContractodAuihorized Agent ' Date <br /> 11� <br />