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PcRMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVIGES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org � <br /> og � 67 <br /> �t� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I) 0� — <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.ri PERMIT p 6O� <br /> �fo q c�u/a, o�— <br /> LEGAL LOTNO. BLOC TRACT � <br /> DESC. <br /> OW ER ADURESS CI IZIP PHONE L S!� <br /> �wS c � �rP� s es 3 ���1 (��on0�✓ay �,,e�-N qg�;�i yzS d8�s <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �d-�Lb��S �NSu�C'�tN�t- ��t' ���� g77- 7SS-a��s <br /> CONTRACTOR G ! ,�„��r ADDRESS CITY2IP PHONE c�����755 <br /> �/Lr7� <br /> CONTR.IICENSE# )M� ��� � °°a5 <br /> Sr���i�1c95�1�/� ISiSN ��rc���.i ,O,C Qge��3 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �( e-�1) I 5���✓1�� _Electric _Gas!Other � �00 <br /> K <br /> WORK DESCRIPTION <br /> �Y//�ll � /l �z ' �'�C/ �� /'✓ L� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR�TEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal � Gas fireplace <br /> Dishwasher Gas ranye <br /> Clothes washer Clothes dryer <br /> Water heater Ranc�e hood <br /> Sink(servicelbar/mop/e1cJ Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodslove <br /> Roof drain; Other <br /> Olher <br /> CITY OP EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicalion and know the same to be true and correct AI�provisions of laws and <br /> ordinaces governing Ihis type of work will be complied with whether specified herein or not The granting of a permil does not presume <br /> to givc authority to violale or cancel the provision o1 any olher state or local law regulating construction or Ihe peAormance of <br /> conslruction.T t I a rized by the owner of this property to pedorm the work for which appGcation is made and I comply with the <br /> Slale ConG r � � 7 RCW and 296.200 WAC. <br /> �� G' <br /> Signalure o(OwnedContractor/Authorized Agent ale 1/2 <br />