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P�r21VIIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETI', WA 98201 <br /> ' 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS ��d/ I PARCEL TAX I.D.# PERMIT# �— <br /> r �� > s� r��- .Loos��+ �o�lot b o � U� �7- �S <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. ON S <br /> OWNER ADDRESS CITYIZIP PHONE <br /> !/!�/11��. SQuARL' �/1/IIG�M�NIS /. J•I'�fC ��s`� �AIDl�ON115f1 (l� /J �>�gl <br /> TE�NT NAf�E CONTACT FOR PERMIT � PHONE <br /> �,`�" � �I Je.e,c.y n,a z� �., y�2s=�7�F��f/ <br /> CONTRACTOR A�DR SS CITY/ZI? PHONE <br /> oc,yr�p�c h�+�w�c.�� snr� yss-��y�1r�tl <br /> CONTR.LICENSE# <br /> L l OO/ 2171� 6�ti r . �pj� /rjou !�qllri c.�./ZACtf 9!'U <br /> US OF BUILDING HEAT SOURCE �NTRACT P ICE OF WORK <br /> �GT*lL OFFiCC,y _ElecMc �' Gas_Other I � � <br /> WORK ESCRIPTION �5/�iLl. Z- iZu�FTpy NI/AG l,�N1 IS G��T�] r�,v�s.f.d ,p uG�Wop�fC./ <br /> z—tXN+�kS! F�aNSJRNO GAS Pipin��CZ1 <br /> i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilel 'Z A/C—air handling unils <br /> _ Bathtub Forced air syste:ns <br /> _ Lavatory (wash basin) 2 Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> ,_ Laundry tray Range hood <br /> _ Sink(service/bar/mop/etc.) _� Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> Iordinaces geverning this type of work will be complied wilh whether specified herein or not.The granting of a permit does nol pres�me <br /> to give authonty to violate or cancel the provision of any other state or local law regulating consiruction or the per(ormance of <br /> construction.That I am authorized by the owner of this property to per(orm the work for which application is made and I comply wilh the <br /> State C clors Law 18.27 RCW and 296?00 WAC. <br /> 7 /� OS <br /> Sign re of 0 erlContract Authorized Agent D e <br />