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P�RMIT APPLICATIruN <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br />APPLICtiTIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS t PARCEL TAX I.D. A' <br />G�% G /V (} re .«A Uq Y <br />LEGAL LOTNO. BLOCK TRACT <br />DESC. <br />OWNER ADDRESS CITY21 <br />n ttxn <br />I'� U L�� I�t,�CP F✓: �c /�- ✓'�eJ- � uTC. 132 I C o�h �{ q.�, <br />TENANTNAME <br />('M�t�,ccL �Pcn�d�_ <br />CONTRACTOR D �Ma^� � 5 � C�K <br />sr <br />_�CONTA-CT FOR PERMIT <br />1 'f I�C�S1,,, ✓ <br />ADURFSS <br />s'YSG i4�aP�••i' I�•, <br />CONTR. UCENSE M D I A�''1 O QC O(p(p �✓.I <br />USE OF BUILDING I HEAT SOURCE <br />1+1 �� • c� l �2 � � �,. ,;/ s � Eleclric _ Gas __ Othe! <br />WORK DESCRIPTION <br />IHS'r�il 2�a� p..� <br />a� z �-, �..�i,r �, ��, t- s <br />PLUM <br />NO. � N�E OF FIXTURE OR ITEM <br />Toilcl <br />f3athlub <br />Lavalory (wash basin) <br />Shower <br />Kilchen sink 8 disposal <br />Dishwasho� <br />Clothes washer <br />Waler healer <br />Sink (service/badmop/elc.) <br />Backflow prevenler <br />Urinal <br />Drinking Fou�lain <br />Floor drain <br />Grease trap <br />Roof droins <br />Other <br />-- �� -U6 <br />PERMIT <br />Mv�u �-��-( <br />� ��L� `Z(e /� Zooa <br />PHONE <br />3�v- 33; -'�Si' V <br />CITY2IP PHONE <br />��w 3�c-�SY-3`o,. <br />6r I I ��ti l.� .. .�YztL <br />CONTRACT PRICE OF WCRK <br />2Coc0 <br />�'� <br />C��.S /'���c T 2 N�✓ <br />�Dv��-u��'�1'i1e�h. �:..�r� M-oc�o��-o�� <br />NO. I TYPE OF FI%TURE OR ITEM <br />A/C - air handling units <br />Forced air cyslems <br />Gas piping <br />Water heafer <br />Gas fireplace <br />Gas range <br />Cb ies dryer <br />Range hood <br />Ezhaust (an <br />Heat pump <br />Unit heater <br />Doiler <br />Fefrigeralion <br />Wo�dslovr, <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceriti(y that I have read and examined this application and know the same W be We aid correct. All pmvisions of �aws and <br />ordinaces governing this type of work will be complied with whelher speci(ied herein cr nut. The granfing of a permil does nol presume <br />to give authority to violate or cancei the provision o( any other slale or local Iaw regulaliny construction or the performance of <br />construclion. That I am authorized by the owner of this property to perform the wo K for which applicafion is made and I comply wilh the <br />Slate Co trzctors Law 18.27 RCW and 296.200 WAC. <br />��.��%�� `i- I 3 —o � I <br />Signefuro ot OwnedCon'raclor/Authonzed Agent Date I <br />--- - ----- - ---_. J <br />