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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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT q <br /> 3�a �- c.,���7�y1„-� fa • SC� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �cr 'i�ti1C ����. y� 3bo� -k�Z(' �j �`e ���e7t 4'�.s'�3l �v�o], <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> ge� 4�5- S 3 i '�Yq3 <br /> CONTRACTOR DDq�SS CITY2IP PHONE <br /> �11� ec� C�•-+s�Uc-Fr�nLv�c. �c�� y���c �/O ! wr��d„�.,,,r !(a_ �&07� K1S' 8bQ-?LIn3 <br /> CONTR.L�CENSE# R. LL T G`'C i /3 ( C P, <br /> U�OF BUILDING ( — HEAT SOURCE I C�ONTRACT PRICE OF WORK <br /> �.�t An-ri r-� Electric Gas Olher 9 3 9/ <br /> WCRK DESCRIPTION (� J �� 4, ,� S-�o1� Q 5 [3 S�7 T vns . .,��rs ��I <br /> 1�'L✓1'1JtJ-a'. C� 1` (�OL 1✓! Li P�' <br /> I>cw }�f( --� 6�S�a�l �O t, c c_^r c o n�-�� /��'v�->%in e� <br /> J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Tnilel A/C-air handling units <br /> _ Balhtub Forced air systems <br /> _ Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposai Gas fireplace <br /> Dishwasher Gasrange <br /> _ qothes washer Clolhes dryer <br /> _ Waler heater Ranc�e hood <br />' _ Sink(service/badmop/elc.) Exhausl(an <br /> _ Back(low preventer Heat pump <br /> Urina� Unit heater <br /> Drinking Founlain Boiler <br /> _ Floor drain Refrigeration <br /> Grcase lrap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby cerili(y that I have read and examined Ihis applicalion and know the same to bo lrue and correcl. All provisions of laws?nd <br /> ordinaces goveming this type ot work will bo complied wilh whelher specified herein or nol.The granting of a permit does nol presume <br /> to give authority to violate or cancel the provision o(any other state or local law regulating conslruction or the peAormance of <br /> conslruction.Thal I am aulhorized 6y the owner o(this property to pedorm tho work for which applicalion is made and I comply with the <br /> State Cor�q�Clors�La��18.27�d 2�JC,.200 WAC. <br /> G 1/ �9 <br /> it[� r �z'- �'�-c�G. <br /> SignaW (OwnedContra or/A horized Agent Dale <br />