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P�RMIT APPLICATION ��'�3�'� ' <br /> CITY OF EVERETT PERMIT SERVICES �a `�� �-06 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ���,�� , � <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM fI� � G�� - l� <br /> SITE ADDRESS ,� I PARCEL TAX I.D.# PE�R�MIT�N� <br /> I L '� ii�w a� �� o�� s b �G 3 0 � Ucx� e:do�" 7d0 <br /> LEGAL LOTNO. BLOCK TRACT (� <br /> DESC. �/ �"�- �` -- <br /> OWNER ADDRESS CITY2IP PHONE <br /> ^ 'i �f' ' � C'. H f:��,i � /Uo .�' /Q_/y ST �✓V if i (.T�c� 9�,G7S Z Ub "�35—�7 J 7�) <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> , � . <br /> CONTRACTOR � ADDRESS CITY2IP PHONE <br /> Co1� p, �, r; �,���p �• = � r>.; � io-{U. si- Mupk,� �r�0 Zo(,.-23r--7379 <br /> CONTR.LICENSE# .. -1 q .uZ�J`S • ,/ ' � � <br /> C` l1lrF � nilhGp ��,FR ��S ��fd '�/ �/7/4:�, L�Lt� � �� �5 <br /> USE OF BUIIDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Eiectric �Gas_Other j;i / 7`f / <br /> WORK DESCRIPTION , i � � ��� r� L /, �r; � �,.c,v-�-'/F) (,� <br /> i , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel � A!C-air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) � � � Gas piping <br /> �t- Shower � ; ! Waler healer <br /> � Kitchen sink 8 disposal I Gas fireplace <br /> Dishwasher Gas range <br /> i Clolhes washer _L Clathes dryer <br /> Waler heater �_ Range hood <br /> Sink (service/barlmop/etc.) 7 Exhauslfan i� <br /> Back(low preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Olher <br /> Olher _ <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby cerilify thal I have read and examined lhis application and know Ihe same to be true and correcl. All provisions of laws and <br /> ordinaces c�oveming this lype of work will be complied with whelher specified herein or not.The granling of a permit does not presume <br /> lo give authority lo violale or cancel the provision of any olher slale or local law regulaling construction or lhe peAormance of <br /> construction.That I am aulhorized by lhe owner of lhis property to periorm lhe work for which application is made and I c�mply with lhe <br /> Slale�qnlractors L �18.27 RCW and 29G200 WAC. <br /> 1 J--�� 1� -� <br /> 5 aat re o wrae ionzed Agent Dale <br /> _ �� ,. � . _ � `� ���. <br />