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PEr�MIT APPLICATIOi� <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AfA TO 4 PM <br /> SITE ADORESS �%/-Y V ��/�'�'�r`–�'`'� PARCEL TAX I.D. p PEP.MIT p <br /> �OD �� e/'-r.7�;✓n r -- ,.,,, ,.� , �,� <br /> LFGA�LOT NO. �BLOCK TRACT OR SUBDIVISION JI � <br /> O[SC.J <br /> OWNER �— AODRESS CIfYIZIP PHONE <br /> �G� %�G <br /> TENANT NAME CON CT FOR PERMIT PHONE / �7 A <br /> �U�/ 1`�C �'IjTL���IJd���-�� �EMAIL��6� v�J � <br /> �bA�A�bI�--- --�bbft�$$ P3i�— <br /> � 'i�Lc��,�p� lN!��� I�n��,a�C� � <br /> CONTR.LICENSE p �� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I' <br /> fJr'IL��G� _Eleclric _. _ Gas _._Ulher / 2�� G�] �� <br /> --1— � <br /> WORK OESCRIPTION CC� (y1 <br /> /A��S T/� c�(„ ���t7s` /►'1 c�n u� _/{ r� 1?,C- �7�. <br /> — - -- — --- ---------------- <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR li[M NO. TVPE OF FI%TURE OR ITEM <br /> Toilol � � NC - air handlin�unils <br /> Balhtub __ Forced air syslems <br /> Lavalory(wash basin) _ _ Gas piping <br /> Showcr W aler hea�cr <br /> Kilchon sink 8 disposal Gas fireplace <br /> Dishwashcr Gas ranc�e <br /> Clolhes washer Clolhes Arym <br />. Walor hoater Rango hood <br /> _ Sink(service/bar/mo�i�elr..) Fzhausl fan <br /> _ Dackllow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Rolrigeration <br /> Gr��aso Irap Woodslovo <br />' Roof drain= Other <br /> _ ���19f _ _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby ceritify thal I have read and oxammed Ihis application and know ihe same lo be lrur.and corroc�. All provisions ol laws and <br /> ordinaces goveming Ihis lype of work will be complied wilh whelher specilied herein or nol The granling ot a pormit does nol presume <br /> to yiv� �ulhority to violate or cancel Ihe provision o(any olher state oi loc:�l law regulating cunstruction or lho per�ormance ol <br /> construclion Th�d I am aulhorized by ihe owner of ihis propehq to perfonn Ihe worh Inr which applicalion is made and I comply with iho <br /> Stal onlradors Law 18 7 CW nnd 2 G.200 WAC. <br /> I�j�y� � J <br /> (cil_��—�--� �3 `� •�. <br /> Signaturc al OwnodContnctoriAulhnrved Agent D;dc 1/z <br />