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F��RMIT APPLICATIt�N ��,a,�b� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-881 U- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /\ l� �a""�d� <br /> SiTE ADDRESS �rn/���� PARCEL TAX I.D.M PERMIT N <br /> C/II� "��' pc�J��lZ � 0 30070 ,/�o6c�R — oYb' <br /> LEGA LOT NO. BLOCK TRACT <br /> UESC. <br /> OWNER /� ADDRESS CIiY21P PHONE <br /> ��/(.sj2 �A/2A-�/ /'6(�'�JEryJtrCS Z � Z� �,UGI�L�A✓E��oo <br /> TENANT NAME PH�J �(/�� %Jrf� C NTACT FOR PERMIT PHONE <br /> r'v�c/ �Go hf C N r n� �6 ��i �/ 20 <br /> l�Ni}7 NA�`'1 b-U�kH <br /> CONTRACTOR���S�f � � 4.� ��a�ADDRE33 CI7Y21P PHONE <br /> ` Y ( 2��8n� !63�fi wmoD„�t1�L I�G <br /> CONTR.UCENSc N ��S T � PM o Z 7Po � �0 7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> [,� �_ <br /> �L��I A�/L�� � _Electric �Gas_Other � �j�� <br /> WORK DESCRIPTION <br /> � �'�� c� E Pc,uM�� � � ��z �,✓� � �5�� �� <br /> i1'� G �t S ri�� /c d P A i 7c� �J � (�-v� p.�E►.�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXiURE OR ITEM <br /> _L Toilet A/C—afrhandlingunils <br /> Bathtub Forc:ed air systems <br /> �, Lavatory(wash basin) � Gas piping <br /> Shower � Waterheater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher ,� Gas range <br /> Clolhes washer _ Clothes dryer �✓ <br /> � Water heater _ f:ange hood � <br /> ___�_ Sink(service/bar/mop/etc.) _ Exhaust fan � 3�� <br /> Backtlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boller <br /> � Floor drain RefrigeraUon <br /> Grease trap Woodstove <br /> _ Roof drains � Other D�' �/L}��JZ <br /> _ Othef � SOVG S-7n [�L QO�r <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereh•�cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordir. ^overning this type of work will be complied with whether specified harein or not.The granting of a permit does not presume <br /> to gi . �..iority to violate or cancel the provision of any other state or local law regulating canstruction or lhe perfortnance of <br /> construction.That I am authorized by lhe owner of this property lo perform Uie work for whfch application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> //—.----Z�- r�— z s—o 6 <br /> Signature of Owner ontractor/Authorized Agent Date <br />