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P�RMIT APPL�CATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S7REET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J� / 7��7 I <br /> �ITE AD(D1RESS � � PARCEL TAl(I.D.1� �RMI�` _ D// i <br /> �J GL n � <br /> �`CiCJ� <br /> LEGA LOTNO. BLOCK TRACT ', <br /> DESC. I <br /> OWNER ADDRESS CINIZIP PHONE <br /> S�l,c�t �roQ'-�t'�!ES ►� 84� 19 5 �1�� wA 9�20b _.� <br /> TENANTNAME CONTACTFORPERMIT PHONE � <br /> lu h 7�• ' <br /> CONTRAC R�IQ e.�l�cn����,.9 ADS.{-S S–.$ � NFS`{ �1N�O1'IYDG' PHONE ,3(pQ �YL/ <br /> o 7 <br /> CONTR.LICENSE 1l vvV(,"TG fy�3�jCJ � U a�C3 C � � ' I <br /> USE OF BUILDIN��� — HEAT SOURCE CONTRACT PRICE OF WORK I <br /> � I Electric Gas_Olher �(/!/ � � <br /> WORK DESCRIPTION �?yl'LQ O�� � ��Ir� � f uc up EKcsf r h y � S'e� �(/i2�P�/"� <br /> C f o�e.-( d- �it t�a-far� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> 8alhlub Forced air systems <br /> J_ Lavalory(wash basin) _ Gas piping <br /> wg�� Water healer <br /> � Sitchen sin�&-disporaL ROL(s1lt S4'i Ql'I C� = Gas fireplace <br /> �� r � Gasrange <br /> Clolhes washer _ Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust lan <br /> Backllow prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler � <br /> Floor drain Refrigerelion <br /> Greasetrap _ �Noodslova <br /> Roof drains Othor <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby centify lhat I havo read and exa ' ed lhis application and know the same to be W e and correct. All provisions of laws and <br /> ordinaces governine�Ihis typo of work� I b complied wilh whelher specified herein or not.The granling oi a pertnit does not presumo <br /> lo give aulhority to violate or cancel lh pr vision o(any olher stata or local law regulating construction or ihe pertormance o( <br /> co Wclion. Thal I am aulhonzed by h wner of this property lo pedorm the ti�ork tor which application is made and 1 compty wilh the <br /> S ate ontraclors Law 18.27 R �a 296200 WAC. <br /> f� � / � <br /> Sig e o(OwnedContractodAuth zed Ac�ent Date <br />