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� PERMIT APPLICATION ' <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9'201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM I <br /> SITE ADDRESS PARCEL TAX I.D.iJ P �� � <br /> i .�b'� 9 Q�u A wn qve, z9oS2 00 0 00 � � "� � <br /> LEGAL LOT NO. BLOCK TRACT <br /> � �ESC. I <br /> I OWNER ADDRESS CINIZIP PHONE � <br /> Ge.rU45 � 3 �09 l3rondwA� A✓� �UoroTi, ��A `rBZp / ' <br /> TENANT NAME CONTACT FOR PERMIT PHONE '�, <br /> r-���,��s �,�5 � �,M ao�- �;,✓ zad - Z74 -y96 � <br /> CONTRACTOR r ADDRESS CITYIZIP PHONE . <br /> AC � �R.Jil !'.!E FfuTe�.l�vt� � (j0�( yZD Y/�SlaN�wA �YOSc 106-bb�2 -bb�(p �, <br /> CONTR.LICENSE li n e 1 I� �� 'D L L I <br /> �� L <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK . <br /> O��-�e _Eteclnc _Gas_Oiher ��. <br /> WORK DESCRIPTION <br /> f{AD z9 pe��.rN; Sr� ;NI( 1zfS • 7C MATcH r+�ew w.� t� <br /> 1� <br /> LAycuY lo �X37'�n/s sysrcr� �I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF fIXTURE OR ITEM <br /> Toilet __ A/C-airhandlingw�its I <br /> i,c!htub _ Forced air s�slems � <br /> Lavarory(wash basin) _ Gas piping I <br /> Shower _ Waterheater , <br /> Kitchen sink&disposal _ Gas f replace II <br /> Dishwasher _ Gas ran9e I <br /> Clothes washer _ Clolhes dryer � <br /> Laundry lrey __ Range hood I� <br /> Sink(service/bar/mop/et�.1 _ Exhaust fan �� <br /> Backflow preventer _ Heat pump ' <br /> Urinal Unit heatcr <br /> Drinking Fountain _ Boiler j <br /> Floordrain _ Refrigeration i <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other — I <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 7705 li <br /> I hereby ceritity that I have read and examinPd Ihis application and know the saroe to be true and coved. All provisions of laws and II <br /> ordinaces goveming this type o(work will be complied with whefher speci5ed hurein or noL The granting of a permil does not presume , <br /> to give aulhority to violate or cancel the provision of any other state or local law iegulating construction ur the performance of il <br /> constructioa That I am authonzed by the owner o1 this propeny to pertorm the v�ork tor which application is made and I comply with the <br /> Stale Coniractq�r�La�7 RCW and 296200 WAC:. <br /> ��, 9- z�-o� <br /> Signature oTOv�edContractor/Authonzed Agem Date �/L � <br />