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PErtMIT APPLICATIOIv <br /> CITY OF EVERETT PERMIT SERWICES <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 T04 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT t <br /> / y /S (�� F �e - <br /> � LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> / v n I S!�u � ���� �(`,c /�!/r �vt� �$Lo / 5'zs z Sf�'-�f YoS <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> i�, 4.. y E�/ Cl/, /s ti�1 �f2i- zsq-z/c / <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �f�4ns�I� `J��S 9' JP�y� �viC <br /> 3�o r ;�.��.-..�'�`'* �vr,,t7`y' yZ�= 1 >Y-I �6/ <br /> CONTR.LICENSE N v{fZ C/ <br /> EY'LANSSoy 2 <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> / , �i <br /> C -o:��i� /✓i��� Eleclric �` Gas_Other (> �(�Q � <br /> WORK DESCRIPTION /J <br /> / �' / /`a�•f ��c!JC <br /> r�) �/��F� C '� ��� q�C i . <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toltel A/C-air handling unils <br /> Balhlub � Forced elr syslems <br /> Levatory(wash basin) _ Gas piping <br /> Shower W ater hoator <br /> Kitchon sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothos dryor <br /> Wator heater Rango hood <br /> Sink (sarvice/bar/mopfota) _ Exhaust(an <br /> Backflow prevonler _ Heat pump <br /> Urinal Unil hoater <br /> Drinking Founlaln _ Boiler <br /> Floor drain Retrigeration <br /> Groasetra�, _ \Noodslove <br /> Roof dralns Other <br /> Olhor _ <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> I hcreby cerilify that I have raad and examined Ihis applicalion and know lhe same to be lrue end correct. All provislons of lawe end <br /> ordinacos governing Ihls type of work will be complieA wilh whetY�.r specified hareln or not.The granting of e permit daes not presume <br /> to givo author!ly to violate or cancel the provision ol any other slate�r local law regulaling constructlon or the peAortnance o( <br /> construction. That I am aulhorized by tho ownar of Ihis property lo pei lorm Ihe work for which appllcation ie made end I compty wilh Ihe <br /> Sla�o Conlr • rs Law 18.27 RCW and 296200 WAC. <br /> �"� ' // / � - /O -G7 <br /> SlgnaWre ol Owner/ ontractodAuthorized Agent ate <br /> �- -- ------- <br />