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PERNlIT APPLICATION <br /> �iTY OF EVERETT PERMIT SERVICES (/ � a 6-ocS� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-a810 — FAX 425-257-8857—wnvw.everettwa.org M � �(/ —U�( � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �LpG <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � � - 21�1 l,{/ , b � ,^r,-�-, � ��c o � S��6c� -O 2 Z <br /> LEGAL LOT NO. BLOCf: TRACT OR SUBDIVISION# <br /> DESC. 5` � (Z�O (J-Qt � <br /> OWNER ADDRESS CITYIZIP PHONE <br /> T.U��1'Y'ee.+� �c�. �u�u�c/�r�a�. l-GC �Ve.�'�`�- t,t� � _ <br /> TENANT NAME f ' CON f T FOR PERMIT PHONE <br /> ��I /�,-/ n.,, zo �- y I Z- �-f�(� 7 <br /> 4/ I I�\` �ee �L�M� (�!?)JV�S�' 1 E.MAIL <br /> CONTRACTOR , ADDP,ESS Cli'riZIP PHONE <br /> hlEK�Sn�OG�',5 W1G�tU1-Vi�-'tl� <br /> CONTR. LICENSE# ��L� ` O,rl C{ SC rS�,}' �� ���)y(�'�1�f77 <br /> kl��9S'So3 �l! �ENrof�� � 9�DSS __ <br /> USE OF BUILDING HEAT SOUP.CE CONTRACT PRICE OF WORK <br /> ���"1�� _Electric �Gas__Other .� l 3,o 0 0 <br /> � <br /> WORK DESCRIPTION ^ /I ^ ��,.,2�e .Ju � � <br /> P tJ cT �,�/�R K O n� �dC � �J � I I �� E�c� 5�' � <br /> � o o'nr '�' v <br /> PLUMBING MECHANICAL <br /> NO. TYPF OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> BathWb Forced air systems <br /> Lavalory(wash basin) °� Gas piping <br /> Shower Water hea�er <br /> Kifchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heaier Ranc�e hood <br /> Sink(service/bar/moplelcJ � Exhaust fan <br /> 8ack(low prevenler Heal pump <br /> Urinal Unil heater <br /> �rinkin� Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap 1Noodstove <br /> Roof drains <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihal I have read and examined lhis applicalion and know the same lo be true and correcl All provisions of laws and <br /> ordinaces governing lhis lype o(work will be coinplied wilh whelher speci(ied herein or noL The granling of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any olher slale or local law regulatin5 construclion or lhe periormance of <br /> conslruclion. 7hat I am authorized by lhe owner of lhis property lo perform ihe work ior which applicalion is made and I comply with lhe <br /> Slate Con��ctor; La��27 RCW and 296.200 WAC. <br /> % ' �, _..—' / Z�' �� <br /> Sign� "�e of O +� Conlractor/Authorized Agent ale <br /> Y,J <br /> � <br />