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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 /> APPLICATtONS ARE ACCEPTED FROM 8 AM TO 4 PM � —�3 ...O 7 <br /> SITE ADDRESS C TAX I.D.N PERMI;11 <br /> Z?Z� A�s �i T qs�l O°"�°��`-� .- =7 <br /> LEGA LOTNO. BLOCK TRACTOHSUBDIVISIONN <br /> DESC. ZtJ,� � �� <br /> OWNER ADDRESS GTY21P PHONE <br /> Z929oW� U.� .1►tAu,� 1ZI� 6¢AtJo1�IE F�l� `19Zo1 41�•?�t-cBc.B <br /> TENANT NAME I CONTACT FOR PERMR PHONE 4.�- ZSq�O$to� <br /> /(�{�� W E�IAIL <br /> 0lnr�IC <br /> conrn.uceNse x <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��� Electric � Gas_Other d�0��� <br /> WORK DESCRIPTION <br /> TENh11T 1.�(�aoJEHMT �v �-R-E?eeE 11EW o(�ICE '�Re�c �o w+[u�xC. t�e7�yE SPite.�e <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FlXTURE OR iTEM NO. TYPE OF flX7URE OR ITEM <br /> � Toiiet _ A/C-air handling units <br /> Bathtub Forced air systems <br /> �p Lava�ory(wash basin) � Gas piping <br /> Shower � Waterheater <br /> � Kitchen sink 8 disposal .� Gas fireplace <br /> � pishwasher _ �Gas range <br /> Clolhes washer Clothes dryer <br /> Watcr heater Rartge hood <br /> �_ Sinl<(service/bar/mop/etc.) _ Exhau�lan <br /> Backflow preventer Heat pu <br /> _ Urinal �� Unit healer <br /> _ Drinking Foun�ain Boiler <br /> _ Floor drain \ Relrigera�ion <br /> Grease irap Woodstove <br /> Rool drains Other <br /> Other <br /> CITY OF EVF.RETT LOCAL SALES TAIf CODE IS J105 <br /> I hereby ceritify thal I have read and examined ihis application and know Ihe same to be true and cortect. All provisions ol laws and <br /> ordinaces governing�his lype of woik will be comp�ied with whe�her specified herein or not.The granting ol a permit does not presume <br /> to give au;hority to violate oi cancel the provision ol any other state or local law regulating construction or the pertormance ol <br /> construc ' n.That 1 am auth 'zed by ihe owner ol this property to pertorm the work tor which application is made and I comply with ihe <br /> Stale ont ctors Law 18 R W and 29620G WAC. <br /> � US•ZS - ZAl7 <br /> ' alure Chvner/Con or! uthorized Agent Date � <br />