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r <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 FqOM 8 AM TO 4 PM <br /> S1TE ADDRESS PARCEL TAX I.D.# PERMIT <br /> I W GPS�a�� �.r,lt'D -z ��65"1 D l��l I � '�0�� �-� <br /> LEGAL LOT N0. BLOCK TRACT OR SUBOIVISIO�i p <br /> DESC. <br /> OWNER ADDRESS CITV/ZIP PHONE <br /> �CN1t,'�-sE't' �Cd��orn�rJ;�Ms 1430 �1Cp5P� 1-b �(�RC�tC °�82c�} <br /> TENANT NAME CONTACT FOR PERMIT PHONE � f�62 *oQl l <br /> ����_ I Ji►n�lWc �� I�'� ��'�.Ma��tr►e�oaaewtio�as. <br /> �rn' ,t.$D � <br /> CONTR. UCENSE N <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> (01�111��1Z�m Elc�tric Gas___Other � � 5�� �— <br /> ( � — <br /> WORK DESCRIPTION <br /> {Z�U�t(E C R��LA�E S'i�� � F� T�l.A�tiYp LfyJ&��` Rt^tMRS <br /> . <br /> PLUMBING MECHANiCAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TVPE OF FIXTURE OR ITEM <br /> _ Toilel , • , � • ' .' � , ._._ NC-air handling units '� ' <br /> Balhtub __ Forced air syslems <br /> _._ La�atory(wash basin) __._ Gas piping <br /> Shower __ Water hrater <br /> Kitchen sink 8 dispoeal _ Gas lireplace <br /> Dishwashcr __. Gasrange <br /> Clotl��s washer Clolhes dryer <br /> - -- WaLiheater ___ Rangehood <br /> __ S:nk(serviceibailmop�etc.l _ _� Exhausl lan <br /> --- Backllow p�evenler _ .._ Heat pump <br /> Urinal __ Unit hea�er <br /> _ Drinking Pountain ___ Boiler <br /> Floordrain __ Refrigeration <br /> _ Grease trap Woodstove <br /> � Rool drains .._. OIhBr_. <br /> --- Other <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify Q�al I have read and examined ihis applicalion and know the same to be liue and correcL All provisions of laws and <br /> ordinaces governing this type ol work will bo complied with whelher specilied herein or noL The granting of a permil does not piesume <br /> to give authority to violate or cancel the provision ol any other state or local law regulating construction or the peAormance ol <br /> construction. Thal I am authorized by Ihe owner ol Ihis property to perlorm the work lor which application is made and I comply with the <br /> St Conlractors Law iB.27 RCW and 296200 WAC Zpp7 <br /> l� (R 23 <br /> nati e of O im onlractouAulhorized Agenl ate � <br /> � �� <br />