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t <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS x �lfAR EL TAX I.D.# I PERMIT# _� <br /> /0�{// lRPo2T R� B/,p(, l ,;.,5 b ��-� 3 ��a a a� �C� ;' �; o � <br /> IEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITVZP PNONE , '� ?_ <br /> 3oD�(,p tLC �f-�o2 Za� ST' E. TA�com�, wA 90�i� 6�8u�3 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> GENsev, iNc. � �n�t�G s� Gi�a�2r za6 -7i�93/ Z <br /> CONTRACTOR ADDRESS CITV2IP PHONE <br /> /f PI°T/EDSNqN�L_l�G NW PS3/ 5. 22zN0 ST. K�7i/i, (�t/A� 980.3 / <br /> �PP1,zHn/o33J'T �- � - OCo 2S3- 3g,s"�-gSDo <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> VV�YRE K'DUSy _Electric _Gas_Other I � /// p p p o0 <br /> WORK DESCRIPTION <br /> �vsT9�� i s l B�ys /�g��E T R�-c% <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ 7oilet AIC—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water healer <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> _ Cbthes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/etc.) Exhaust fan <br /> _ BackFlow preventer Heat pump <br /> _ Urinal Unit healer <br /> _ Drinking Fountain � Boiler <br /> _ Floor drein Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains � Other <br /> Other — <br /> .I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and�xamined this application and know the same to be true and cprrect. All provisions ot laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or noi.The granting ot a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construdion orthe pertormance oi <br /> con tion.That I am authorized by th er of this properry to pedorm the work for which applicatiore is made and I comply with the <br /> S te ntraclors Law 827 R�W an 00 WAC. <br /> r/tn <br /> �/ /�-1�-�� <br /> Signature of ner/ Mractor/Authonzed Agent ate `/? I <br />