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{�cRMIT APPLICAT�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www•evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADURESS � PARCEL TAX I.D.It PERMIT 1t <br /> ��DO� �n1, �ih5/r�o 2D �('OS - Q�� I <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �Jn� f/�G <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �,<,L- il� y ' I �1 ��h�/�o�SK� �IZ�'. ��: -2�9y <br /> CONTRACTOR ADDRESS CITV2IP PHONE <br /> �� � ,�C. <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 72s ��P l7FLIv�r �`'`� � /oQO <br /> � CLf r�-,-E.� _Electric _Gas_Othcr <br /> WORK�ESCRIPTION <br /> � �j) U�s�;�C. � <br /> --- PLUM8ING MECHANICAL <br /> NO. TVPE OF FIX7URE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ A/C- air handling unils <br /> Ba�hluh __ Forced air sys�ems <br /> -- Lav:�lory(�vash basin) -- Gas pipin9 <br /> Shower __ Water healer <br /> Kitcl-,en sink 8 disposal _ Gas lireplaco <br /> � Dishwasher _ Gasrange <br /> Clolhes wsshFr ._ Clolhes drya� <br />� Walr.r hr,ater __ Range hood <br /> Sink(service/badmopletr..) ___ ExhausUan <br /> Backllow prevr.nirr __ Heal pump <br /> Urinal _ Unil hoa�er <br /> i — Drinking Fountain = Boiler <br /> Floor d;ain Relrig�ralion <br /> Grease trap _ Woodslove <br /> Rool drains _ O�her _ <br /> Olher--_-_----_ <br /> -- --- I - <br /> I CITY OF EVERETT LOCAL SALES TA%COOE IS 3105 <br /> i I hereby cerilify lha� I have read and examined Ihis application and know U�r, samo to be Iruo and corracl All provisions ol laws and <br /> �� ordinar,es goveming lhis type ot work will be cnmplied with whether specilir.d heroin or nol. The granling of a permil doos nol presume <br /> �' lo give authorily�o violate or cancel the provisiun of any olher slate or local law regulalin�conslruclion or ihe perlormance of <br /> rnnslruclion. Th�t I am authorized by Ihe ownor ot this property lo perlorm lho work for which application Is made and I comply wilh the <br /> � Stal�,�.o radpfs Law 18,77`RCW and 296.200 W� <br /> /�%� �����-.�Yh S hG <br /> �, SYn.�ire o OwnedContractor/Authonzed Agen Dale <br /> �IZ <br />