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PtRMIT APPLICATIOfV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881�— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PER^f# � <br /> ��(z�- �C-�-�eC-�t2�N b I o 2ocbol�-vc7 i .�1 D �d-- 3� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION X � <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �L��cn2 scH�cl�3z-+Z �R� G-�v �/�t-� ST. STz zID s�f/e �.4 /o� <br /> TENANT NAME / ��� �_ _ G.Oi,�. CONTACT FOR PERMIT �Z�NE�� }� <br /> L �is+� I� µ 7� � Nl.—�—t.� CNo � -zS <br /> I`� �1F' .1�� C . I E•MAIL I����IIC � <br /> CONTRACTOR ADDRESS CITYIZIP PHONE t n <br /> f' <br /> CONTR.LICENSE# T � '� <br /> I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> R'C���t%(� �—�'� ' _Eleclric �Gas_Other l 1� �� <br /> WORK DESCRIPTION <br /> � Ns-rH�-c_, � o'xQ' T�L L t-t�oP (�v Lx� s i� ��y �ZL--�T�ctr , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXI'URE OR iTEM NO. TYPF.OF FIXTURE OR ITEM <br /> Toilel A/C—air handling unils <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) I Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas freplace <br /> Dishwasher � Gas range <br /> Clofhes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/elc.) �_ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease lrap _ Woodslove <br /> Roofdrains t Other "TY1�C— � �-{-a�h <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> I hereby cerili(y lhal I have read and examined this applicalion and know lhe same lo be lrue and correct. All provisions of laws and <br /> ordinaces ga��:ning this type of work will be complied wilh whelher specified herein or noL The granling of a permil does nol presume <br /> to give aulhorily to violate or cancel the provision of any olher state or local law regulating conslruction or the performance of <br /> conslruction.Thal I am aulhorized by the owner of lhis property lo perform the work for which application is made and I comply wilh the <br /> Slale Contrectors Law 18.27 RCW and 296.200 WAC. � <br /> �'1n,� .�� � �� v s� <br /> SignaWr�(Own /Co tra�or uthonzed Agent Date 1I <br /> 2. <br />