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y ��RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIGINS ARE ACCEPTED FROM 8 AM TO 4 PM �D(pG�-03S� <br /> �ITE ADDRESS �� ! �ARCEL TAX IA��Q� Q �RM� � <br /> . C.Z/ � i�v= <br /> LEG LOT NO. BLOCK TRACT <br /> DESC. �_._----- ' � -�----. <br /> � OWNER AD RESS CITY2IP Pl{qyF,,�_3�8'j�� <br /> i� �Y�� <br /> �-t�*�� z�� l�z: O�,..,+��� �,�c.c�., W.�y �r_...���' <br /> IENANT NAME CO ACT FOR PERMIT PHONE <br /> � i <br /> f S� / a�/Y�,"74f1lJ U��-%?Q� <br /> CONTRACTOP. � � ���� ADDRESS�6(�/�e_ Q,��� CITY2IP PHONE <br /> � � C� ST.��'/�r''��/ �/a-a=7Jz/-3/ <br /> CON7R.LICENSE# ��AQ �,l( 5'fcYvV> � <br /> p2�s�'rxr�;� q�� Grt� roc1�F <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �j� ,� _Electric Gas_Other � +� <br /> -��-�K�- / <br /> WORK DESCRIPTION ���0�� 2/ nG ��� ��� `��� u S�S <br /> R�v � <br /> S�A'lqC�� q•.J �' �iDC — .4�i�v /�-i2 on1 �c/G3?-/�i! <br /> '�/f,�lll � [ �i /� ,!I s�orL/ _ !�t�5/ Sf-�CiO. <br /> LUMBIKG y ME HA ICAL <br /> NO. TYPE OF Fi%TURE 6R ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—a(r handling units <br /> Bathtub Forced air systems <br /> _ Lavatory(wash asin) Gas piping / L <br /> Shower Waler heater �{f.� <br /> = Kitchen sink disposal _ Gas fireplace � �� / <br /> — ishwasher Gas range �� / ,�, �i' <br /> lhes wa er Clothes dryer /�� / <br /> _ Wa r heater Range hood �� <br /> _ Sink ice/bar/mop/etc.) _ Exhaust fan �; ,;� ' <br /> _ Backfl reventer Heat pump � t/ �� <br /> _ Urin Unit heater �K� <br /> _ Dri ing Fou ain _ Boiler <br /> F ordrain Refigeration <br /> rease trap Woodstove <br /> Roof drains Other _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritiry that I have read and examined this applicalion and know the same to be We and conect. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whelher speciGed herein or not.The grantlng of a permit does not presume <br /> to give authority to violate or cancel the provision of any other slate or local law reguladng construction or the perfortnance of <br /> construction.T t I am authorized by the owner of this property to pertorm the work fnr which applicadon is made and I comply with the <br /> State Conlr ors Law 18. R and 296200 WAC. <br /> � � G � a 6 ( <br /> ' alur r A orized Agent Date �/L <br />