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� F �RNlIT APPLICATIv�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, NA 98201 <br /> 425-257-8810— FAX 425-257-8857—ww�v.everettwa.org � b ,.,D �j—6 j <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PNf - DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �u� ��U � 2��Z <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZiP PHONE <br /> c�C� -�ul�7T a�o� c�12 sz .�v�1�7r �a.�� 4z5 �����Z <br /> TENA NAM� I CONTACT FOR PERMIT PHONE <br /> �"�,�2/s .CAi21� 4zs -Z57- �5�17 <br /> CONTRACTOR ADDRESS CITY.21P ONE <br /> � � <br /> /� � � (., . . <br /> CONTR.LICENSE# �/S // ,v�i, �!l;'� �. i� r,.� <br /> ,�.ty <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WOFK <br /> � — _Electric �Gas_Other �� � � �-�'� <br /> WORK DESCRIPTION <br /> �fiIA�TT- IM(��MC-t,�' TD ftPPIZDX• 3r� � GUH/G� /N' Es , <br /> ��y.�;E�,r,t1 �/�/���}7LY2 �f1�2 Gf1GY�..IL. ,9N� �L1oIJ/�/�l�TIC�i/S To 7X'� <br /> F�CIsTI� f{U�G SZ7=N) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TIPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) Ga;pipin� <br /> Shower Water heater <br /> Kitchen sink&disposal Gas firaplace <br /> Disliwasher Gas range <br /> Clolhes washer Gothes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmoplelc.) Exhausl tan <br /> Ba�kOow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> I Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Ili Roo�drains Other <br /> I Other <br /> i' D D <br /> l '�, CIN OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify that I have read and eramined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied with whether specified herein or not.The granting of a perr..�' �ioes not presume <br /> � �Ito give aulhority to violate or cancel the provisior.of any other stata or local law regulaling construction or the perf:�miance of <br /> construction haLl am authorized by,lhe owner oi this properry to pertorm the work for�vhich application is made =.�id I comply with the <br /> I State ra ors Law'I 27 RC, a(�d 296.200 WAC. <br /> � � — <br /> i � ' �/,/, � <br /> . /� ;' ...,j j �'`�r�� �� ��F—lc�,/ <br /> f, <br /> Signature of Owned o traclor/Authorized AgeN ' , ate <br /> '� <br /> � <br />