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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <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 S —I 3�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI� # <br /> �7.;� � 0 0 �8'D/3 Z �� �;� -� � `r <br /> LEC.1L l0T N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> JWNER ADDRESS C�TYIZIF PHONE <br /> ���t �-t-Zi,�A-,��tii��n '��z � /.dTu�1���i� � k�t1�— <br /> TENANT NAME CONTACT FOR PERMIT PHOy E <br /> �oS��7'/Gi.�L,drl� �f.'S-�"/�-//$5� /�� � <br /> E•MAIL /'Z�(ty(��72/21�' <br /> ONTRACT R ADDRESS CITY/ZIP PHONE" <br /> 4ttJ�'. �01s�f�—.�/.ullf7�/ �7y� Cd�f,t,LtfBK/.A'��*-t ���U7¢ �05 <br /> CONTR.LICENSE# l�zS_>p�/ — /'�T7/�3 <br /> !/ 4w 7 <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> c _ _ / ��� [lectric l�Gas Othcr ��� 7j � .— <br /> .�L�Y�� <br /> WORK ESCRIPTION <br /> �"a,e.e�-���g-TE 3 cou-Lu�-wa�..�,. � � �� 2amc�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Bath�ub Forced air systems <br /> Lavalory(wash bas'n) _ Gas pipin� <br /> Shower _ Walerheater <br /> ' _ Kitchen sink 8 disposal � _ Gas tirepiace � <br /> Dishwasher Gasrange <br /> Clothes washer _ Cbthes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backllow prevenler __ Heat pump <br /> � Urinal _ Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Reirigeralion <br /> Grease Irap _ Woodslove <br /> Roof dreins _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TNC CODE IS J105 <br /> I hereby ceritify Ihat I have read and examined Ihis application and know lhe same lo be true and correct. All provisions of�aws and <br /> ordinaces governing this t •o(�vork will be complied wilh whether speci(ied herein or nol.The granting of a permil does not presume <br /> to give authorily to viulate or cancel the provision o(any other slale or local law regulaling conslruction or lhe performance of <br /> � construction.That I am aulhorized by the owner of Ihis proper�y to perform the work for which applicalion is made and I comply wilh the <br /> Sla�o Contraclors La� .27 RCW a 296.200 WAC. <br /> , �� � � <br /> � ure Ow e CoNraclodAulhorized Agenl Dale <br /> �—. - -- — _ <br /> - -- --- -- —I <br />