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� P���RMIT APPLICATI �' �� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8657-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 2`a,��D 9 <br /> SITE ADDRESCS \ -_) PARCEL TAX I.D.x PERMIT�l� <br /> �SCCJ C�v�'Sl(Z��'-1J I.JI.� <br /> LEGA LOT NO. BLOCK TRA OR SUBOIVISION K <br /> DESC. <br /> OWNER ADDRESS CfTY21P PHONE <br /> TENANT NAME I CONTACT FOR PERMIT PHONE '� "}_Q�"� • G} <br /> +�ya.r.s�c, � .4-mc�I.�G�1 ���- ' `�Ma �j <br /> C�v,\l..�S 1�-a�+� , �r-�. � t}� �- �J <br /> coNrR.uCFN�x G Ltil� vq�'i O ��/,-�-5i .�._ �l�lO�- �1'�•�-�rt •� <br /> USE OF BUILDING l7/7/J�> HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ''�'ti—� _Electric _ Gas_Other � � � �U U <br /> WORK DESCRIPTION .��G _��,�_ ���S�i ��� ���-7'r�,�" L� N�� <br /> �f7��dnC_ �L� <br /> PLUMBING MECHANICpL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR REM <br /> Toilei _ A/C—air handling units <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping � <br /> Shower _ WaterFwa::r <br /> Kitchen sink&d�sposal _ Gas fireplace `y� <br /> Dishwasher __ Gas range �\, <br /> CloUies washer _ Clothes dryer �/� l <br /> Watar heater Rango hood � \ <br /> Sink(service/bar/mop/etc.) _ Erhaust fan ^ � � �� <br /> Backflow prove�ter _ Heat pump \1 �Y <br /> Urinal _ Unit heater �X v <br /> _ Drinking Fountain _ Boiler . <br /> Floor drain _ Refrigeration � / (,/ <br /> Greasetrep _ Wooasrove � �• <br /> Roof dra�ins y _ Other � <br /> _ Other �{rtL—rtr�=� — ;� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity that I have read and ezamined tliis applicauon and know the same to be true and cortect. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not The grantinp of a permit does not presume <br /> to give authority to violate or cancei the provision of any other state or local law regulating conswc5on or ihe oertortnance of <br /> construction.That I am authorized by the owner of this property to pertorm ihe wortc tor which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> �-' 1`�-� c� <br /> Signature of Owner/ ontracro thonzed Agent 'Date <br /> /Z <br />