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PtRMIT APPLICATIGN <br /> CITY OF EVERETT PERMI i SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPL�CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 3S/� �a�����c�,�i�2 0 - � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBOIVISION# <br /> OESC. <br /> OWNER ADDRESS Clm�� PHONE <br /> I(��/iC1 ' 'iti � y-zstr- y 7 <br /> �U(vi'ie 1t 7 / Y' L�� � ,�Ct nJil.� • �f �(/�TLO/ � z O <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> y ��q�ff2L ,�/�c' �,G yz � - z35"-i�.�6' <br /> ��i p�� �t P P.�iM 5 i�o� �ira. 5 C -. t( �/S/^ E-M.41L <br /> NTRAC OR R S LITYI . <br /> �//,��'�t.r- S��*S '� S'N.-z�,:_^ ��O / �ivt��,�t...c <�Z>: Z�'-9- Z./,�, <br /> CONTR.CICENSE# <br /> ,Ei�/ �9�Vs5 o�iZ/s 2 �,��Y�J�"z v� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRI�.E OF WORK <br /> /S�� S' �Electric _Gas_Other <br /> Z 700 �� <br /> i <br /> WORK DESCRIPTION <br /> �,,y�" ���_� ��✓L ����i-!�!/ �� . <br /> �/� / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. � TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balhtub = Foresd air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler!�eater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Ranc�e hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> �ackflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Reirigeration <br /> � Grease trap _ Woodsrove <br /> Rouf drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i hereby cerilify thal I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whelher specified herein or not Thn granting of a permit does not presume <br /> to give aulhority lo violate or cancel Ihe provision o(any other stale or�ocai law regulating construclion or tho performance oi <br /> construclion.That I am aulhorized by lhe owner o(lhis property to perform the work(or which appiicalion is made and I comply wilh lhe <br /> Slale Conlraclors L�w 18.27 RCW and 296.200 WAC. <br /> � / , / � '7/-C,� � . <br /> ��r,.� � � � <br /> Signature of OwnedCon rac or/Aulhonzed Agent Date <br />