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� -- <br /> PERMI� APPLICATION <br /> CI7Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425•257•8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.p PERMIT�- <br /> I w cas� D ��� -3� o�65t o 10l /S '�o�- � <br /> LFGAI LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DGSC. <br /> OWNER ADORESS CITY/ZIP PHONE <br /> �R�9� �AF k CcNoorn�rl;�Ms ►43o WC�si►� I�V �f�CC °I82o�} <br /> TENANT NAME CONTACT FOR PER1M'IT PHONE � (pdZ �I I <br /> $ph��� I .JII��AG�it� i��L$JRJf �Gt��•Ma�JiM@IalDduaAEWIR�S. <br /> -Z�dpTF� �D 21F— <br /> CONTR. LICENSE M <br /> USE OF BUILDING I HEAT SOUfiCE I CONTRACT PRICE OF WORK <br /> COf��1'H��TU�'�1 � _Elec�ric ___ Gar _ _otner � 2' ��0� �— _ <br /> WORK DESCRIPTION � <br /> ��E � �tu�� s�o»sc� t� � r��'� �uJ�.oPE a�MRs <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIxTURE OR ITEM NO. TVPE OF FIl(TURE OR ITEM <br /> ' Tpilel ' . � ' � � � . _ A/C�'air hand6n�units � , <br /> bathWb � __ Forced air syslems <br /> � Lavatory(wash basinl ---- Gas pipi�.ig <br /> . . —� shower _.. �� water healer <br /> Kitchen sink 8 disposal __ � Gas lireplace <br /> Dishwashcr . _ _ Gasrange <br /> Clothes washer , _ Clothes dryer <br /> Walerhealer _ _ Range hood <br /> Sink (servicc'badmop�etc 1 ___ [xliaustfan <br /> Backllow preventer . __ Heal pump <br /> Uiinal __ Unit hea�er <br /> Drinking Foun�ain ___ BOiler <br /> Floer drain __ Felrigeralion <br /> Grease trap Woodstove <br /> Fioof drnins ___ Other <br /> Othei <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerllily that I have read and examined Ihis application and know Ihe same lo be true and correcl. All piovisions ol laws and <br /> ordinaces governing this type of work will be complied with whether specilied herein or not.The granting ol a permit does not presume <br /> lo give autliority to violate or cancel the provision of any olher stato or local law regulaling construction or Ihe perlormance of <br /> construction. That I am aidhorized by the owner of this property to perlorm tha work lor which application is mado and I comply with the <br /> SI Contractors Law 78.27 RCW and 296.200 WAC. �jp7 <br /> u�j [� 23 <br /> nati e ol O ier ontr2ctor�Authonzed llgent ate II� <br />