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PERMIT A�PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREEI", EVERE'TT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—v,nvw.everettwa.org � � 6...p(� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.if pE&MI7# <br /> c'o�-13 U� zs- Go�l3 rb o� �. (:.r>, � . <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYZP PHONE <br /> �b-� IM�I�Dvtce,C-� C/2S .'1 S7 ��7�i� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �, �, ;��,r "7'i7-L-� I �T�►M CMi�q�.2 �/z� d'�2 /zu c� <br /> CONTRACTOR AD�RESS CITY/ZIP PHONE li-- <br /> �7`/E S�q�i `acfO' c�/s �-rrr �. �ti✓ktaar� ,p �l ' <br /> CONTR.LICENSE# � C-1�2 �z���� <br /> ��9 k� � ��- oa�? i ,� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �j�lS/ N-'r'Sl _Electric _Gas_Other � e�'� <br /> �d <br /> WORK DESCRIPTION •rN 5/'�- � � <br /> •l� � �� Su-��� C a u o f'/ tM v��n 'I-�o� i rY'�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXNRE OR ITEM <br /> _ Toilet NC-air handling units - <br /> _ Bathtub Forcedairsystems <br /> _ lavatory(wash basin) Gzs piping <br /> Shower Water heater <br /> _ Kitchen sink&disposai _ Gzs fireplace <br /> _ Dishwasher Gas range <br /> __ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/etc.) _ Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Unnai Unit heater <br /> Dnnking Founlain Boiler <br /> _ Floordrain Refigeration <br /> _ Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EV.:RETT LOCAL SALES TAX COGE IS 3105 <br /> I hereby ceritify that I have read and examined this ap��Iication and know the same to be true and wrrect. All provisions of laws antl <br /> ordinaces governing ihis type of work will be complied with whether specified herein or not.The granting of a permit does noi presume <br /> to gi �authority to viola[e or cancel the provision ot any other state or local law regulating wnstruction or the perforznance of <br /> co rudion.That 1 am aulhorized by the owner of this property to perfortn the work For which application is made and I comply with lhe <br /> St .Contractors Layr 1}3.27 RC�nd 296.200 WAC. <br /> / / r <br /> �(�%L <br /> 5 re of Owner/C ntractor/Authorized Agent Dat�e� 1 i <br /> � <br />