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( <br /> � PERMIT APPLICATION <br /> CITY 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 /> 14 o W �Ps�a�a �0�'P - Iq oc�b651 0 lol Q 70�- yo <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER AODRESS CITV/Zlp PHONE <br /> SQNC:�LSE'1" {�h�.k (�10oMitJ�JMS 1430 Vl1L{�51� � �t�IY °I�°�2� <br /> TENANT NAME CONTACT�OR PERM"!� PHONE � 662 *0211 <br /> c`�C�r� �DRk I .J1N$(AG�iA� �1L�I" �� _ "E•MAIL�JIM�F�dP�iI�W�Q�7S. <br /> _L�6NTA'7�i. �D � <br /> CONTR.UCENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRAGT PRICE OF WORK <br /> (,G1�����t�m I ___Electric __._ Gas .__ Olhcr � ` 50� �_ <br /> WORK DESCRIPTION <br /> ��E � ��E S'I��q � �t f�l-A��(p �-`►�1J�L` RIf'�tI.�2S <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> ' Toilet , . ' ' ._. . A'C-'aii handling units' � . • • <br /> Ba1Mub � � __ Forced alr 5ys�ems <br /> Lavamry�wash basin) _ _ Gas pipin� <br /> Shower __ Wnter healer <br /> . _ Kil�hen sink 8 disposal . _ Gas ir.eplace <br /> Dishwasher _ . _ Gas ranga <br /> Clolhes washer Golhes dryer <br /> Water heatr,r � Range hood <br /> _ _ Slnk(servicNbadmop'elcJ . EMhausl fan <br /> __ _ � Backllow preventer . __ Heat pwnp <br /> Urinal ___ Unilhcater <br /> __ Drinking Fountain ___ Boiler <br /> Floor drain __ Relrigeration <br /> .-__ .. Grease Irap Woodstove <br /> Roaldrains . , Uher_____ ___ __ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE I�3105 <br /> I hr.reby ceiility thal I have read and e�amined this applicatlon and know the same to be true and co�rect. All provisions ol laws and <br /> ordnaces goveming Ihis lype ol work wlll be complied with whethe�speciGed herein or nol. The granting of a permit dces nol presume <br /> tu gWe aulhority to violate or cancel Ihe provision of any other state or local law regulating construction or ihe performance ol <br /> construcuon. That I am auUiorized by Ihe o�vner of this property to perform Ihe work lor which applicalion is made and I comply wilh the <br /> SI Cont�actors Law 18.27 FiCW and 296200 WAC. �7 <br /> W U� 23 �. <br /> nati e ol O �en onlractor�Authorized Agent - - – ate ---- — II� <br />