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P�tRMIT APPLICATIG�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX�.D.# PERMIT <br /> 3 �p �� �L�_ �`)b53/oo�0o5GY� /�- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION It <br /> �ESC. <br /> OWNER AODRESS CITYIZIP PHONE <br /> f.��-f�J C�wa-� (1l b-r"' � �� �S�"-342-7y� <br /> TENANT NAME CONTACT FOR PERMIi �HQNE3� _S Z��� <br /> �� �,�/�,(/�_`�� �'IOl'!�{ ��YI�1�L wr� E�HIAIL <br /> Nf��Fo �����7oM TO !03 � � �N r�l�,776`�b <br /> (l�&�C Ruict !f yql1U� K� <br /> CONTR.LICENSE N � � cn:�.�j��j✓I�LQ/"7��Y <br /> fl <br /> USE OF BUILDI G HEAT SOURCE CONTRACT PRICE OF WORK <br /> �i `��L,� f�,� _Eleclric �Gas_Olher "�(j�� <br /> �WOR��K DES_CRIpTION (1 � (�,_7�� �J�-�71� 11� �11G4 r�- `IZ' R.f•�•�� 1�L�2.� � <br /> � � � hv <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM ' NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> �athlub Pnrced air systems <br /> Lavalory(wash basin) � J_ Gas piping <br />' Shower - Water heater <br /> Kitchen sink 8 disposal Gas tireplace <br /> Dishwashcr Gasranye <br /> Clothes washer Clothos dryer <br /> Water hoater Range hood <br /> Sink(se�viceNarlr„o�>/elc.) Exhausl lan <br /> _ Dackllow prevenler ' _ Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain Boilcr <br /> Floor drain Refriperation <br /> Grease Uap Woodslove <br /> Roof drains Olher <br /> Othcr <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceiitify Ihat I havo read and examined Ihis application and know Iho same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis lype o(work will be complied wilh whether specified herein or noL The granting o(a pertnit does not presume <br /> to give authorily to violale or cancel lho provision of any other slale or local law regulating consWclion or the podorm2nce of <br /> cons�(uclion.That I am aulhorized by the owner of this property to peKorm the work for which application is made and I comply wilh Ihe <br /> StateCortraclors aw"'1�. 1tC�J �i�d296.200WAC. <br /> ( � ��� ��� ���-� ��- <br /> / � , <br /> �Signat�ro of ned oNractodAulhorized Agent �alo <br />