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PtRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 9B201 U �G� lp I <br /> 425-257-8910— FAX 425-257-8857 —www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��G /O� <br /> SITE ADDRESS /�I � PARCEL TAX I.D.it PERMIT# <br /> - IL T c OVS9 o a� � 7<<' ���v <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. �3 (p n� <br /> OWNER AODRESS CITY2IP PHONE <br /> ��S ��r,eumm �oad go�heCC C4zs)7sq-zo� <br /> ST�UEN 7-nNAI �pA/DSV��K Co�s �• <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> _ ST�fJF� �./1NIYVF�Ik SAti't � <br /> CONTRACTOR ADDR ESS CITVIZIP PHONE <br /> SrEUEN T LANDSVFi2k c.ovKtru�+iniJ L�C 3��/iaCC r..�19 <br /> CONTR.LICENSEII 9gD12 (4zs))Sq-zt��Z <br /> �T�vE T �_ q S8 Kc� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S �/� _Eloclric x Gas_Olher L��).:>�'�`� . <br /> t <br />� WORK DESCRIPTION <br /> i <br /> �2��J �� �Lc���L, �,. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIxTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> � Toilel A/C—air handling unils <br /> _� 6a1hWh � Forced air sysl�ms <br /> _(Q Lavatory(wash 6asin) �� Gas p'�inc� <br /> �_ Shower Waler heater <br /> �_ Kilchen sink 8 disposal � Gas fireplacc <br /> � Dishwasher a Gas range <br /> � Clolhes washnr � Clolhes dryor <br /> �_ Waler heator _� Rango hood <br /> __ Sink(sorviceNadmop/elr,.) _� Exhaust(an -- �� <br /> Backllow pr�ven�er Haal pump <br /> Urinal Unil heater <br /> Drinkin�Pounlain �oiler <br /> Floor drain Refrigeretion <br /> Groase tr;ip Woodslovo <br /> Rool dralns Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby corilify iha�I havo read and examined this applicalion and know the same to be lrue and coirect. All provisions o�laws and <br /> ordinacos govominy ihis type ol work will be complied with whelher specilied hereln or noL The graMin�ol a permit does nol presume <br /> to give euthority lo violate canccl the provision of any othor s�ate or local law regulating consiruction or the perlormance of <br /> conslruclion. Thal I am Ih� nzeA by th�owner o(�his property to pertorm�he work lor which application is made and I comply with Ihe <br /> S�alo Con r,ors La 18.2 �A 29f.200 WAC. <br /> e <br /> SiQ . o n - ICun�ractorlAulhorized Agent Date <br /> ��� <br /> ` <br />