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"!V� ^�� <br /> PE N11T APPLICATION <br /> CITY OF EVERE i T rFRMIT SERVICES 5 Jl��� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 / �� <br /> ' 425-257-8810— FAX d25-257-8857 —www.everettwa.org � �Ci, <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT�t � <br /> i� � - ,, , � ; � -� -� <br /> LEGAL LOTNO. BLOCK TRACT <br /> IDESC. <br /> OWNER ` I ' I ADDRESS CINIZIP PHONE <br /> I �l��2/V 1 �i1 I � V..I,M '�"yll � `�ln� �d��1'l �'--ti7UL ��ei�l(S?�� _G�P.�1 ,�� � <br /> j TENANT NAME CONTACT FOR PE IT PH��`= <br /> jl �^ I <br /> l i� ��V/ � � <br /> '' CONTRACTOR ' � C���y'��� � ADD�tES I�CITj21P HONe . w� c� <br /> � � 11 �- (,�'(�,�(� l5'_'��- �c�(,�,r'Y\liyifi� `�Z��c�o� I� � <br /> CONTR. ICENSE# �� <br /> ,1'� l��i Il n?�C�'1 (�'�C;v�-4- I�tT_�'1,�11ut <br /> USE OF BJIL4iNG HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Electric ��Gas Other �� r c �(� <br /> � , "r�+ ' ' <br /> il WORK CESCRIPTION ���� I , ��(J`�Tl� �.1��� 1 ��1��; � �Ce� � ���� � ���i � I <br /> �( 1��,'� �11 ��� � � � 1 ) 1.�1 �i1�`' C�'X�'l�,t,� �c�1'1 W � G{l.lL�'WGY� . <br /> v <br /> I <br /> i PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet �. aC–air handling units <br /> I Bathtub Forced air systems - <br /> I _ Lavatory(wash basin) � Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace � �� <br /> Dishwasher _ Gasrange � <br /> Cbthes washer _ Clothes dryer <br /> ' Laundry tray Range hood � /�,,� <br /> ! _ Sink (service/badmop/etc.) � Exhausl fan � �-� <br /> Backflow preventer _ Heal pump /� <br /> � Urinal _ Unil heater <br /> '. Drinking Fountain _ Boiler <br /> � Floor drain _ Refrigeration <br /> _ Grease trap � Othe�S��Q�� ( 1 ST�� ' <br /> �� Roof drains <br /> Olher — <br /> i — <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> �. I hereby ceritify that I have read and examined this application and know the same lo be true and correct. All proviswas of laws and <br /> i ordinaces goveming this type ot work�vill be complied wilh whether specifed herein or nut.The graniing of a permi;does not presume <br /> � ro give authority to violate or cancel the provision of any other state or local law regulaling conslraction or the performance of <br /> 'i construction. That I am autho(ized by lhe owner o(:his property to perform the work for which applicalion is made and I comply with ihe <br /> State Cojitractors Law,],$.2fRClN and 296.2C0 WAC. <br /> a <br /> �,C�(� 4,L� � � � <br /> Si ature of 0 ner/ContractodAut i ri ed Agent D e <br /> � 2 <br />