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d^1 �' <br /> n , � ���i�. G i 2 i . � <br /> n:-� �� 2:� 12 uIJ�AI�I <br /> PERMIT APPLICATION <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 C�DAR STREEI', EVERGTT, WA 98201 <br /> 425-257-SE310 – FAX 425•257-8857–vJww•everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM `�7.��—/Z <br /> PARCEL TAX I,D•tf PEHMIT'ti <br /> SITE ADDRE5i5.t, .�}� (1^�/� , <br /> 1�1 �fP�Pi11 � O/.NI � a (���_ �'IC <br /> LEGAL . LOT N0. 6LOCK TRAC7 OA SU�DIVISION p <br /> DESG. <br /> QODRESS CITY2IP PHONE <br /> OIYNEH ��`� �� <br /> �DY� I I.�iU'Q/I � CUNTACT FOR PEH�1 T PHO��E n / ,^ <br /> TENANTNNAE L��GjZ��A ��^'� `�' <br /> I ��b� E•1.7AIL <br /> / <br /> - �(� a � Inc' 1�5 i3rcadu� 6�e,rerl' �2S L�� (ofo(a�a <br /> CONTR.LICENS[p���J �o(�G��, �g�l <br /> —I J <br /> USE OF 6UILDING HEAT SOURCE CONTRACT PRICE OF�YORK <br /> � <br /> _Eieclric �Gas_Other �O�q 3 <br /> WORK�ESCRIPTION �i�s.�� I qGs -Fv rr�ac.�• -t 5as �2a <br /> Run C�Gs �i (�it�g <br /> pLUMBING MECHANICAI. <br /> NO. 7YAE OF FIXTURE OR ITEPd N0. TYPE OF FIXTURE OR ITEP�1 <br /> Toilet A/C—air handling unlls <br /> N Bathtub ^ Forcod air syslems <br /> Lavalory pvash basin) � Gas pipin{� <br /> Showar 1 Water heater <br /> Kitchen sink&disposa� _ Gas flreplace <br /> � Dishwashor _ Gas r2ngo <br /> Clothos�.vasher _ Clothes dryer <br /> Water I,eater _ Ranpe hood <br /> Sink(service/hadmop/etc.) _ Ezhausl tan <br /> 6ackUow preventer _ Hoal pump <br />� Urinal _ Unit heoter <br /> C Drinkinp Founlain _ Boiler <br /> � Floor drain _ Re(rigeration <br /> Grease Irap Woodstove /�� <br /> � Rootdrains �, Other�fiS 'Nft\QLf, <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and oxamined this opplicalion and know the same lo ba Irue end correcL All provisions o(lav:s and <br /> ordinaces c�ovorning thi9 type of work will be Complied wilh whe�hpr Specified herein or noC The granting of a permil tloes not presume <br /> to�ivo au�ho�ity ro violale or cancel F�e provislon of any olher stata or Iocai la�v ragulating consiruction or lho aedormance of <br /> construclion.That I am aulhnr�ze9 by the owner ot lhis proper�y�o perform ihe work for which applicalion is made and I comply v+ith ihe <br /> � State Contractots Law 7827 RCW and 29G.200 WAC. <br /> I'�,bbi� ,,v g•9 i�- <br /> S��nature o wneAComr ctor/Aulhori Agent D3te <br />