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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8870—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM g �� � � <br /> SITE ADDRESS PARCEL TAX I.D.A pE-RM�T f <br /> 2�2S W�TMOI�L /�}11�.. oo�t39�1. 1200 � 1�1 D fl 'O�S <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. 1Z 6� <br /> OWNER ADDRE � /� �-I1 p� ' CITY/LP PHONE <br /> (�Z,�\ ��{,y,7pW� IM'� pyd L 11AWNR <br /> J��►cs 1�4��.� S�;k. z� w� q�osi, <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ��.t...��� LeA-s; a T I �� U o�MrJL 2Db 36'7 2300 _ <br /> CONTRACTOR PS � �13�ZSSML ISs�� CITY PHON�` �,� ,�� <br /> CONTR LICENSE/��yrh59 t,y�T WI� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � _Eledric �Gas_Other JP r � (( � <br /> WORK DESCR�PTION DGNb exc s�+� y-To.. ��c�C oP �' ��-� �� <br /> p�.k h,Y ��. N�.s. E�� �,ndL �.da�.u- r.�c.,, �-T«, P.,�,h.R ►.o��,p c,,,;}-. <br /> RtK„c�r•��-E iS 1.:1c.e.-�- l..�Ice.. us;�•� ¢ac�s�t-.� G�A-b� D�tofs .G- D;s�t;lw.�;o-� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(vrdsh basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposai Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry�ray _ Range hood <br /> Sink(servicelbar/mopletc.) _ Exhaust tan <br /> Badctlow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Flocr drain Refngeretion <br /> Grease trap Woodslove <br /> _ Roof drains � Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby centify thal I have mad and examined this applicalion and know the same to be lrue and corted. All provisions of laws and <br /> ordinaces 9overning Ihis type of work will be complied with whether specified herein or noL The granting ot a pertnit dces not presume <br /> to give auUionty to violale or cancel the provision of any other stale or Iocal law regulating construdion or the pedormance of <br /> construction. Tlial I am authorized by the owner of this property to perform the work for which application is made and I wmply with Ihe <br /> Stale Conlractors Law 1827 RCW and 296.200 WAC. <br /> SignaWre ol OwnedConiractodAuthonzed Agent Date �/ <br /> ,2 <br />