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PtRMIT A�'PLICATIUN <br /> CITY OF EVERET7' PERMIT SERVICES <br /> 320G CEDAR STREEI�. EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-25�-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (+ �� � -0(p <br /> SI7E ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ��.� ,� c'�dysly�//ol90� � o�oy - oyT <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER { ADDRESS CITYIZIP PHONE <br /> � e �� / N�i<YC I U > 6r��j �c//�� %c� �U.i / C �.7�— `/ /�f� <br /> TENANTNAME CONTACTFORPER PHONE <br /> ;YrSC� '7 i L x C ���v <br /> CONTRACTOR .� ADDRESS � CITY2IP PHONE <br /> c�r-F,�,� �r,.,- ,o>-„ „7�� � <br /> CONTR.LICENSE# �y /"C '/����G_��/C� <br /> �t/ 7 � ! <br /> USE OF BUILDING HEAT SOUR�CE I CONTRACI PRICE OF WORK <br /> �^ y� �J �k;� �7 � '= <br /> i t_ l/Or/ar _Eleclnc _Gas_OTher �5 DlJ�. <br /> � <br /> WORK d SCRIPTION <br /> � � �d�-o��t So•�t ui� ��� f.E� So�-.,e. Atw '�••;5��3. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhlub Forced air syslems <br /> Lavatoty(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Water healer Range hood <br /> _ Sink(service/badmop/elc.) _ Exhaust fan <br /> Backllow prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby centify thal I havo read and examined this appiication and know the same to be true and correcL All provisions of Iaws and <br /> ordinaces governing this type oi work will be complied with whelher specified herein or not.The granting of a permil does not presume <br /> to give aulhorily to violale or cancel the provision of any other state or local law regulating consWction or the performanco of <br /> cofi�ruction.Thal 1 am autho)r'zed by lhe owner of lhis property to perlorm the work for which application is made and 1 wmply with the <br /> Stale�Conlraclors La + 1�2yRC,W �id 296200 WAC. <br /> ' `��`' ' � -�6 <br /> , ,� ,,�, _ i <br /> SiynaWre o wner/Cont a /Aul nzed" gent Date <br /> ; � : - ,l <br /> �' <br />