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P�i .MIT APPLICATIOi`�- <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 9F201 � � i� -O� <br /> 425-257-8810- FAX 425-257-8857 -www.everetlwa.org �_\ I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��—_� i _ f <br /> SITE�DDRESS ��` , �� ' � � PARCEL TAX I.D.# 17T# rt <br /> �;: <br /> b IJ -.� '" r ;:w� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. � <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��G-�2��iJ �LET,�iZ ����e <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> !'�i- M �[YLUN Cc 'NCt�y�'� (y25�?7�t S�a� <br /> CONTRACTOR �-^ DDRESS ��'Lv ��� Z CITY2IP PHONE <br /> �v�2�e�cU cTtn�r�nC P �,z <br /> CONTR.LICENSE# � � S+ ru'Lfi�� �,(,u(�-�-eo (�06�-7'���`( <br /> tv�a,�'a�;9r q 6 41 N _ <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric �Gas_Olher /� � Qb � <br /> WORK DESCRIPTION �� � / � � . <br /> (; 2oov✓1 �{ x „ T��S-f�.tf A6s ,p , .�es� <br /> S�t 5��t�li ,�4,�ck b�'�� �. �L�r�� �-� � g �,%� k s -to w�ns-t-e 1�y o <br /> � � ,� �i -�2 c.c. -t �til < <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balhlub Forced air systems <br /> c� Lavatory(wash basin) Gas piping <br /> Shower -� Waler healer <br /> Kilchen s�nk 8 disposal Gas 6repiace <br /> Dishwasher Gas range <br /> Cblhes washer Clolhes dryer <br /> = Water heater Range nood <br /> � Sink(servicelbadmop/etc.) � Exhaust fan <br /> Backflow preverter Heat pump <br /> Urina� Unil healer <br /> .Drinking Founlain Boiler <br /> Floor drain Refdgeratlon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOC.1L SALES TAIC CODE IS 3105 <br /> I hereby ceritiy that I n.,ve read and axamined this application and know the same lo be Irue and correct. All provisfons of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granling of a pertnit does not presume <br /> lo gfve authorily to violate or cancel the provision of any olher state or Iocal law regulating construcUon or the perfortnance of <br /> conslruction.That 1 am eulhorized by lhe owner of this property lo perform the work for which application is made and I comply with the <br /> Stale Contractors Law t .27 RCW and 296200 WAC. <br /> . ��v—_ fls/n�, J a`7 <br /> Signature o(Owner uthorized Agent Da <br />