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�cRMIT APPLICATIt�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 5-257-8810- FAX 425-257-8857-www.everettwa.org <br /> � <br /> CU�'�Y�(� P�NT'}bI�SE A PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �. �j —Q Q <br /> SITE A z A W�Y �1 c�. PARCEL TAX I.D.!F PERMI N <br /> /�1TG K.���i ���"��u• y' zo3 �l� ,�� � ' �O/ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> COWNER ADDRESS CINIZIP PHONE <br /> 1-VcYtif �K�°`�� �0���� Zeq�"SbWE2 ST �Vere"r}� wa • 982v� <br /> TENANTNAME I �CONTACTFORPERMIT PHOlIE �6� _S�.z1 <br /> �V6K� (.OWw�.� �IF�� I II I VE 1��R� E-MAIL <br /> N R T �i4N'IOiU D v l'�1�'�WS I �AE— <br /> 3�43� A�rPur�' flr• �3ell�iirJa�►t� �- <br /> CONTR.LICENSE ll �—�� UR�.0�� �� Gp'�6 <br /> �� �� /O <br /> USE OF BUILDING HEAT SOURCE I C NTRACT PRICE OF WORK <br /> ���r I <br /> _. , . CDcafr ,� ZS ac� • �� <br /> �CLNMo��yT^'��'�� r _Electric Gas_Olhcr I / <br /> • a <br /> WORKDESCRIPTION (�,�e �,�(s�-i� 3e�LL�' � 2nst'u� �w ���r <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIX7URE OR ITEM NO. TYPE UF FIXTURE OR ITEM <br /> Toilet AIC-air handling unils <br /> Dathtub Fomed air syslems <br /> Lavalory(��ash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink 8 dispusal _ Gas lireplace <br /> Dishwashcr Gas range <br /> Clolhes washer Clothes dryer <br /> Water Lealer Range hood <br /> Sink(service/badmop/r.lc.) _ Exhaust lan <br /> Backllow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grcase trap _ Woodstove <br /> Roof drains O f _ Olher <br /> � olher Dpih.tr . — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 7105 <br /> I hereby ceritify thal I have read and ezamined Ihis applicalion and know lhe same to be Irue and correcL All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specified herein or not.The granting o(a permit does nol presume <br /> �o give aulhoriry lo violafe or cancel the provision of any olher stale or local law regulaling conslruction or the performance of <br /> conslruclion. That I am aulhorized by Ihe owner ol Uiis propeAy to perlorm the work for which application is made and I comply wilh Ihe <br /> Stale Conlractors Law 18.27 RCW.nd 296200 WAC. <br /> � :-�� / 2 <br /> Signalure of OwnedConirar.lo rized Agent . Date <br />