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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 �l� ��p� -0/.,L <br /> SITE ADDRESS PARCEL TAX I.D.# MIT !' <br /> �n �t'� ���io `( wv.� � ��''� �Jl� <br /> LEGAL LOJ NO. BLOCK TRACT OR SUBDIVIISrION M <br /> DESC. :P� p� - . . �i�l: '�"� Ob c#c � � '� <br /> OWNER ADDRESS CITY2IP PHONE 4 j,f'-jt�y'yB) <br /> C� �Phrl /�o�QleA�l IIZ�—I 3�'�`` DrL SE C(�Y1�--'f`� 4�J/� ��0& <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> (�� i�v,r,) I�"fo�(r.t.� ��,J h'�oC�n«l E�a2S= 3�/�./—c(872. <br /> �YR TO A�SD ES 21P <br /> CONTR.LICENSE p yzr�`�`�<,�7 <br /> f'�r� I? (� AGTgSo� Z � ► Zi� 3�r�"`� 7�zsc ��v��e�-iT 9� Zo� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��� l _Electric �as_Other �/,SOO� DD <br /> WORKDESCRIPTION ��-�,� � j��,., Z000 ,5 r-� ).fpu�i , � <br /> � � n�-� <br /> S�-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ,�_ Toilel I � i A/C-air handling units <br /> Balhtub I I f Forced air systems i <br /> � La�•alory(wash basin) �s 1 / �� _ Gas piping <br /> �� Shower V � Water heater <br /> �_ Kitchen sink 8 disposai � � Gas f,replace � <br /> r Dishwasher v i Ga:renge <br /> i Clothes washer � ClUhes dryer y <br /> � Waler healer � Range hood <br /> Sink(service/bar/mop/elc.) �� Exhausl fan i l� � � <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountaii� Boiler <br /> Floor drain i� Re(rigeration <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAJ(CODE IS 7705 <br /> I hereby ceritify lhat I have read and examined this application and know the same to be lrue and correcl. All provisions of laws and <br /> ordinaces goveming this lype of work will be complied�vith whether specitied herein or not.The granling of a permit does nol presume <br /> lo give aulhority lo violate or cancel Ihe provision of any olher slate or local law rec�ulaling construclion or lhe peAormance of <br /> construction.Tha[I am authorized by Ihe owner o(lhis property lo periorm the work for which application is made and I comply with the <br /> Slale Conlraclors Law 18.27 RCW and 2962 WAC. <br /> � - l ,� /'�v ���/O <br /> Signature of OwnedContractodAulhonz Agent Dale t/ <br /> �L <br />