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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everellwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM 7/D�/O(7 <br /> SITE ADDRE S ' S � PARCEL TAX I.D./ PERMIT N <br /> 00� �- ��s��a � 080�- -��il� <br /> LEGA LOT NO. BL9CK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��� f�L <br /> TENANTNAME / CON CTFORPERMIT ��MOWE ,f7��'Z�p )/ <br /> �0�1f� ��� �17���� e�a�d ✓Y �I <br /> '� LG/L�O� lti!�U} j'21��, I� <br /> CONTR.LICENSE N ', <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> (�r-'�L I(;� _Eleclrlc _Gas_Other <br /> WORK DESCRIPTION / �� <br /> /,VS�/}c,L 'l�g M� n D u c,/�►`- �3�— �DG - <br /> PLUMBIN(3 MECHANICAL <br /> N0. TVPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toflel A/C-eir handling unils <br /> Bathlub Forced alr syslems <br /> Lavatory(wash basin) _ Gas plping <br /> Shower Water healer <br /> Kltchen slnk 8 disposal _ Gas flroplace <br /> Dishwasher Gas ranga <br /> Clothes wesher Clolhea dryer <br /> Water heater Range hood <br /> Sink(service/barlmop/etc.) _ Exhaust fan <br /> Backllow prevenler _ Heat pump <br /> Udnal Unll healer <br /> Drinking Founlaln _ Boller <br /> Floor draln _ Relrigeration <br /> Grease lrap _ Woodatove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceriti(y thet I have reod and examined this applicalion and know the same to he true and correct. All provislons o(lews end <br /> ordinaces goveming thls lype o(work will be complied with whether apeclfied hereln or not.7he granting oi a permit does nol presume <br /> to give aulhority lo vlolale or cancel the provlsion o(any olher stale or local law regulaling conslruclion or lhe perfortnence of <br /> construclion. Thal I am authorized by Ihe owner af lhls propeAy to peAorm the work for which appllcallon Is mede and I comply wilh lhe <br /> Sta�onlractors�w 18,z7 CW and 2 8.200 WAC. �� <br /> �� � O � <br /> ignalure fo Ow edContractorlAulhodzed Agent Date (/ <br /> � <br />