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� PERMIT APPLICATiON <br /> CITY OF EV'ERETT 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 PARCEL TAX I.D.It PERMIT# <br /> 'i�� �3�cudwc� .z� �v-1 alo��S0000020o r,1 70�- 3 � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> ONT7ER ADDRESS CITVlLP PHONE <br /> �V�rC,�� GC��t-w�'`{ C;tVlk1' LL�- 5�,�1� �ocictwc,u� �A��ii 'U 6vt.c+� ,�Jfi �(-?OZI <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �r.�P �nc. IL�nd�.cy �c�lm.er �as� 8,��- q�t��� <br /> CONTRACTOR AD�RE55 CITY2IP PHONE <br /> �Arc1�t�� NCat1r`(10.�'� ���• 11qi4rkhrclR�e I�uklnr�d, v� A 9E�33 `-1Ls-t�Z7 _ {� <br /> CONiR.LICENSE# �J <br /> CnKD_i��AU�7Dg _ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> GU11�11�,(�'�(Ll� aElectric _Gas_Other '� —1 � �'i JZ. LJ <br /> WORK DESCRIPTION <br /> Uc1d S l�r=�1..� c���Cl r eiu�v� du�.t �u�� k +v S PUsC.e <br /> � <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXNRE OR ITEA7 NO. T'PE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br />� Lavatory(wash basin) _ Gas piping <br />� Shower Water heater <br /> Kitchen sink 8 disposal Gas freplace <br /> Dishwasher Gas range <br /> qolhes washer Clothes dryer <br /> Laundry tray _ Range hocd <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil h�ater <br /> Drinking Fountain _ Boiler <br /> Floor drein Refrigeralion <br /> Grease trap Woodstove <br /> _ Roof drains �L Other <br /> = Other _ — �11L�1Yt'k vn�— <br /> _ �:G, ` Z <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ce�itify thal I have read and examined ffiis application and know the same to be We and correcL All provisions ot laws and <br /> ordinaces governing this type of work vnll be complied wilh whelher specfied herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel ihe provision cf any other state or laal law regulating construction or the perTormance of <br /> construction.That I am authorized by the ner of this property to perform the work for which applicatlon is made and I comply with ihe <br /> State Contrad ��s Lav+1827 RCW aynd,:96. 00 WAC. <br /> �"\� ;�n�t_cti � l0 �� <br /> Signatureo edContra u onz dAgent Date <br /> �� <br />