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� PERI1lliT APPLICATI�JN <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 425-257-8810D FAX 425 257 8857E www e e8et�twa.org 3 ` �Z � 85 I <br /> /��L' <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED i <br /> SITE ADDRESS PARCEL TAX I.D.K I PERMIT# <br /> " �. t Rt tAAu U�A`f �- „ <:�>- r, ,,-� <br /> LFGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITVlZIP PHONE � <br /> �9 �'2 GG o— �`'i 7 <br /> S�'�a��c s-� �a.�,p.� :rJ `eZOYb sw/3• c� ,St-�..i N���u� �Yt rss--ezoO-- <br /> TENANTNAME � CONTACTFORPERNAT PHONE <br /> �yv�R(Z"�' f 1�t*� �tt"LS�-1 24g i4� L22'L- � <br /> CONTRACTOR �'p�i1��A S�D [i�' ADORESS CITV2IP PH7NE i <br /> �"��'fli tccy, z)75 I3vf�L Q-� 'Ut Ids- 'J <br /> H �Y•yrrv I <br /> CONTR.LICENSEpS� Dr�Cv'�s� S�( 2AV BCI�rW( U/ yC�S <br /> G O <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �,'�'�,��,.. _e�ectric �cas_o�ner �� jj?�;f ��</(� I <br /> WORK DESCRIPTION O �� ��� �� PJ�,A I� � . ' <br /> Tt'rj+a►.sT �iT �T � � ��, � <br /> , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toi!et A/C-air handling units <br /> � BathWb Forced air systzms <br /> Lavatory(wash basin) 7 Gas piping <br /> � Shower � Water healer / <br /> �_ Kitchen sink&diepeeel / = Gas fireplace j <br /> Dishwasher ' Gas range y <br /> � Clothes washer � � Clolhes dryer � <br /> Laundry iray .. Range hood <br /> � Sink(service/bar/mop/etc)' � Exhaust fan <br /> Backflow preventev'� Heat pump <br /> Urinal .�� � Unit heater <br /> � Drinking Fountain _ Boiler <br /> Floor drain Refryg ration <br /> �— Grease trap = Vjroodstove <br /> Roof drains �Olher � <br /> Olher <br /> � — <br /> i <br /> I _ qTY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> II I hereby centify that I have read and examined this applicalion and know lhe same to be true and cnrrec;. All provisions o(laws and <br /> ordinaces governing lhis type of work wiil be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give authority to violate or cancel ihe provision of any other state or local law regulating construction or the performance o( <br /> construction.That I am authorized by lhe owner of this property to perform the work(or which application is maCe and I comply with fhe <br /> State Contraclors Law 1827 RCW and 296200 WAC. � <br /> �� ��S <br /> Signature of Ow B V2ctodAuthonzed Agent [�e `' <br /> I-- — 1 �i <br /> � <br />