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� PERMIT �PPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 6 � 0 � �p(� <br /> 425-257-8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIQNS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TNC I.D.p PERMIT N <br /> �+ r �7 iJ <br /> � `/ V 1 0\ � <br /> LEGAL LOTNO. r BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PMONE <br /> S f r1 � �'t�� S-� � ��` \ �r_�r�ec—t' I��n: � n �C'�-�n��rn Y?S' �'�I SS <br /> TENANTNAME CONTACTFORPERMIT —T PHONE <br /> KEv � �� �c ; rrc._ Zo (�, 3Q3 87�/� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICCNSE M <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRtCE OF WORK <br /> C O (lU , J� Ct�' �- �Elodric _Gas_Olhor f��� �;G c <br /> WORK DESCRIPTION <br /> --� f �\C��` �_ ;Y���•. c.�.c.1i1 .' i\ �`� <br /> PLUMBING MECHANtCAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet _ WC-air handling units <br /> 8athtub ____ Forced air systems <br /> � Lavatory(wash basui) Gas piping <br /> Shower � Waten c�alor <br /> Kitclion sink 8 dispos�l _ s firoplace <br /> Dis hcr _ G ranao <br /> _ Clolhos hcr ,_ Clot s drycr <br /> NJater heale Rang ood <br /> Sink(sorviceNarlmoplelr..) _(_ Exhaust�Jan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unil hoa�er� <br /> Drinking Founlain _ Boiler <br /> Floor drain Rolrigeretion <br /> Groa�e Irap _ Woodsrove <br /> Rool drains Other_ <br /> Olher_ _ — — <br /> CITY OF EVERETT LOCAL SALES TNC CODE IS J105 <br /> I hereby ceritify Iliat I have read and examinad lhis applicalion and know Ihe samo lo bo true and correct. All provlslon;ol laws and <br /> ordinacos govcrning lhis ty{>e o'work will ho complied�itli whclhor speciliod herein or not. The granling of a permil does nol presume <br /> to givo aulhorily to violat�or cancel ihe provision o(any othor state or local law regulating conslruclior or the peAormance o( <br /> conslruction. That I am authorized by tho owner ol this propedy to portorm ihe work for which applicalion is made and I wmply wilh lhe <br /> Sta�e Cont�raclp�s iaw 18.27 RCW and 296.200 WAC. <br /> ��- _ 5�`��� '1 <br /> Sign ur� OwnedConlraclor/Aulhorized genl Dale lj <br /> l . . . . ___. I <br /> --- � -------__.--- ------- � <br />