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F�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —v�v�nv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> S1TE ADpRESS PARCEL TAX I.D. �' P,€RMIT jt .� <br /> 3 1\� i��a.:\..�c Cv.u�A v�A• l��' � �/ U 7l�/br.� CJ�, ,fC ��) 7 '-�� <br /> LEGA LOTNO. �LOCK TRACT <br /> DESC. t <br /> OWNER ADDRESS CINIZIP PNONE y��_ ysu <br /> Tc•c—\ �c•,Sc�/ �,>�, Sv�X� �ti--1 ��-1�aJ.,..V� `�'6oc. <br /> a ��e�y <br /> TENANT NAME CONiACT FOR PERMIi PI10NE <br /> �-�:3�•.�- Zl�.'.� ����� I Trc� �"l�.n}o:J -�.o�c•4;1.�-`�'1hh <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> V��IU L�� <br /> CONTR.LICENSE# <br /> US[OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 1' <br /> �3 �. 1 �c� �C C �n,,, _Eleclr,c ._� Gas_Other ,;{' -T��(-�� -�' ;C� �7 <br /> WORK DESCRIPTION <br /> i" <br /> n / <br /> ��� � `�� i <br /> J�� - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITENI NO. TYPE OF FIXTURE OR ITEM <br /> Toilel NC—air handling units <br /> BalhWb Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 dispossl Gas fireplaco <br /> Dishwasher Gasrango <br /> Clolhos washer Cblhes dryer <br /> Waler healer Range hood <br /> Sink(service/barlmop/elc.) _ Exhausl fan <br /> Backflow preventor Heaf pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERC•TT LOCAL SALES TNC CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined lhis appliwlion a id know the same to bo true and cortecL All provisions of laws and <br /> ordinaces governing lhis lype ot work will bo complied wilh whether specitied herein or not.The granting ot a permil does not presume <br /> to give aulhority lo viol�te or cancel lhe provision of any other slato or local law regulating construction or tho performance of <br /> consWction.That I am aulhorized by lho owner of this pro��erty lo pertorm lhe work tor which applica6on is made and I comply with the <br /> Slate Conlractors Law 1827 RCW and 29�.200 WAC. <br /> •--1 --�r-'--\�_o � -.�s' Q1 <br /> Signalure of OwnedContractor/Aulhorized Agent Dato // <br /> � <br />