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PERi�IIT 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 3 ,� 9 --O,rp <br /> SITE ADDRESS PAr�CEL TAX I.D.# PE MIT# <br /> 7� � <br /> 5o ROia'awa. �-r -' � / �� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> C��11\1E WrcST�FOi'—� GR-'4+�D �U`c Gu4t-4,T 425- SU9'VYSfk <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> /'nn1�11� l.l�s��uP-4 JP�so�1 �-S� 3z7- 7445 <br /> f.ONTRACTOR ADDRESS CITY2IP PHONE <br /> 4ua��ry l�-i2 Co,�rao� .�,�c. q93� /8m /luE GcJ �g,¢err 9Bzoy �ZfJ <br /> CO�TR.LICENSE p j27- 7�f�/,f <br /> 'Q�r+�- i �c q�PIL <br /> USE OF BUILDING HEAT SOI�RCE CONTRACT PRICE OF WORK <br /> �FPlC £ I _Eleciric �Gas_Olher � 2, oop, Oo <br /> WORK DESCRIPTION <br /> /��Sf9LL ('jNS PIPl�l9 �o� �vRN�rCE S (�rfTf� l'fCM'f� <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEId <br /> Toilel A/C-air handling units <br /> Balhlub ___�_ Forced air systems <br /> _ Lavalory(wash basin) � Gas piping Fv/tnaoc� � <br /> Shower � Waler heater <br /> Kitchen sink 8 disposal Gas firr,placc <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler heater Ranc�e hood <br /> Sink(serviceNar/mop/elc.) Ezhausl fan <br /> Back(low preventer Heat pump <br /> Urinal Unit heater <br /> Drinkiug Founlain Boiler <br /> Floor drain Re(rigeralion <br /> Grease Irap Woodslove <br /> Roof drains _ Other _ I <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 �� <br /> I hereby cerilify thal t have read and examined Ihis applicalion and know Ihe same to be true and correct. All provisions of laws and II <br /> ordinaces governing lhis type of work will be complied wiUi whether speci(ied herain or noL The granting of a permil doos not presume <br /> to give aulhority to violale or cancel the provision of any other state or local law regutating construclion or the performance of <br /> conslruclion.That I am authorized by Uie owner of this property to pedorm the work for which application is made and I comply with lhe <br /> State Co lractors Law 18.27 RCW and 296.200 WAC. <br /> �22rf/,� � �7/ai <br /> �ign u e of OwnedConlraclor/Aulhorized Agent Dat I <br />