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NERMIT APP'f�ICAT�ON -3- �' � ° Y - �z <br /> GITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E�/ERETT. WA 98201 ; <br /> 425-257-8810- FAX 425-257-8�57-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED F�.OM 8 AM TO 4 PM S ` � —O� <br /> SITE ADDRESS PARC£L T1�%IA.# I P�itMIT iF��; � <br /> C, � ° ' " l�L� ---- — j � � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS �� C1TY21P PHONE <br /> � , ✓���i��?olc� 3G 7 Y [°� ��',:�. �."rlcizo8`/ I <br /> TEN NAME CONTACTFORPE � PHONE , <br /> �i��� �r,c � , , �i <br /> �c��, <br /> CONTRACTOR "� ADDRESS CITY2IP PHONE <br /> F�Dn�.Jm� /)�u ..,�iiis Z �1.�.� 0 Izy�f�rNvr�rr rJ�-�..,Jru�- <br /> CONTR.LICENSE# n��� J� n _ __ � ] <br /> �XV 1 N1 f���k � uDil PX L72-C Z <br /> USE OF BUILDING HEAT SOURCE CONTR.4CT PRICE OF WORK <br /> Eleclric Gas Olher <br /> WORK DESCRIPTION <br /> FLUMBING MECHANICAL <br /> NO. TYPE UF FIXTURE OR ITEM NO. T YPE OF FIXTURE 012 ITEM <br /> i Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> � Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kilchen sink&disposal Gas fireplaco <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> � Sink(service/barlmop/elc.) _ 6xhaust fan <br /> 8ackflow preventor Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Ftoor drein Refngeration <br /> Grease trap Woodslovo <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVBRETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ccrilify Ihat 1 have read and examined Ihis application and know the same to be We and correct. All provisions o1 laws and I <br /> ordinaces goveming this type o(work will be complied with whelher specified herein or noL The granting of a permil does not presume <br /> to give aulhority lo violale or cancel Ihe provision o(any other state or local law regulating consWclion or lhe pedormance of <br /> construction.That I am aulhorized by lhe owner ot this property to pedorm tho work for which applicalion is made and 1 comply with lhe <br /> Slalo. ordr eto/rs kaw tg//.27'1�CW and 296.200 WAC. <br /> (///lLGG���i� — <br /> A <br /> Sic�nature of OwnedConlractodAulhorized Agenl Date <br />