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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERI'TT, 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 — O� <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT A <br /> 9�2v c�,.�b:� i�r. ��$dS- Ob <br /> LEGAL LUT N(). BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADDRESS CITY2IP PIiONE <br /> JRr����ll[..t I7 ci Z �w .f'� Sf �k I�oJ 5ua . 9 � � •7� zobxrl - Y� <br /> TENANT NM1E I CONTACT FOR PERMIT PHONE <br /> J�rhr M�rn�� <br /> �� s��a�w�x�k. �1�t Entt� �tZ f e.nea�� yZi 3Y7 �YT/ <br /> �ccc�.rCs+ S�,•vrtt� �^� `M <br /> CONTR.LICENSEM v��a//',���� � � <br /> P/►�cwe-� s q �Y� Ie �� ��2L�3 %O lZ <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 1�s r I �M;� �Electric _Gas_Olher /.� 8�n�7�� r ,� x � <br /> WORK DESCRIPTION ' I <br /> (telaca�c +�� w�1.er � 1�a ; �e T � t}.o�.er �:.dd vo�n�� .. M+"L c y u+��+sn 1 <br /> ciba..f f�,.�nn��1, {��t �r ['�6�fic. Yil 1Ut ctno� Yt�rh� '1�r e�is'�11'� �+{�l+�1 . <br /> J ✓ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR�TEM <br /> 1 Toilel A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Di�hwasher Gas range <br /> � � Ctolhes washer _ Clothes dryer <br /> Waier heater Range hood <br /> Sink(service/bar/mopletc.) Exhaust fan <br /> Backllow preventer _ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease Vap _ Woodstove <br /> Roof drains Other <br /> G Olher = <br /> �= -�a�(�.! - 1'� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify lhat I have read and examined ihis application and know the same to be true and cortect. All provisions of laws and <br /> ordinaces c�ovemin9 lhis type o(work will be complied with whether specitied herein or nol The grantin�o(a pertnit does nol presume <br /> to 9ive authurity to violate or cancel ihe provision ol any other slate or local law regulating wnstruclion or the peAormance ot <br /> consVuction.That I am aulhorized by the owner ol Ihis propeAy to periorm the work for which applicatlon is made and I comply with the <br /> Stale C Iraclors Law 1827 RCW and 296.200 WAC. <br /> y� S�IS D D <br /> Si t re of OwnedContracror/A Ihorized Agenl Date <br /> —-- -- t <br />