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P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881 G- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TA1(I.D.# PERM17 A <br /> �u° l�rcv u�a l+ I�GG og-v (S <br /> IEGAL LOTNO. BLOCK TRACT <br /> p�nr <br /> OWNER AODRESS CITYIZIP PHONE <br /> , / q zvP.��f��, N�fz„3 yzs �1G 93k- <br /> 1�unG{4li 5 ( erisc �ajCev `���C� ��$/z iir�or�«'2U �{vc. � <br /> TENANTNAME CONTAC FPR PERMIT � PHONE <br /> :,/J n�t llJ O G(:'�ti!v' — <br /> CONTRACTOR OLLi��i �� � �7i�./Jp�I If��lKlI�nDRESS dTY21P PHONE <br /> CONTR.LICENSE R <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> �(�'f� Ir� Y:SIL�U'+L'f � Eledric Gas Olher <br /> WORK C'cSCRIPTION r <br /> In�tKr..�f fi�(i��cv�q t�� �r� .Y�YUG�✓cclly Sour�c�. 7urne����o���( 90° � �dc1 <br /> (�($ �ir�id-���� . <br /> PLUMBING MEC'+ANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel A/C—air handling units <br /> Dalhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> SinC(service/badmop/etc.) Exhausl tan <br /> Backflow preveater _ Heat pump <br /> Urinal Unil heater <br /> Drinkinr� Founlain Doiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodslove <br /> Roof drains Olher <br /> Other <br /> — — I — <br /> GITY OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> I herety ceritify lhat I have read and examinotl lhis application and know the same to be lrue and correct. All provisions of laws and � <br /> ordineces governing this type of work will be complied wifh whether specitied herein or nol The grenting of a permil does not presume I <br /> lo give authority to violale or cancel the provision of any other stale or local law regu�ating construction or lhe peAormance o( <br /> construction.Thai I am authorized by the owner of this property to peAorm the werk(or which application is made and I comply wilh the II <br /> StaYe ConUactors L'a'w 18.27 RCW and 296200 WAC. <br /> I` � 1 -�,��/�'c h� �1���' <br /> �� ..„ � <br /> Si 7hature ot- wnodContracbdAulhonzed Agent Date <br />