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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-88�0— FAX A25-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � -- a. �'j.�0% <br /> SITE ADDRESS/ PARCEL TAX I.D.p PERMIT# <br /> ��z�� `ONtGO�,.�� I N1G'l0'1—C��1 <br /> LEGAL LO1'NO. BLOCK �RACT <br /> DESC. <br /> OVJNER � -- � ADDRESS CI7'YIZIP PHONE <br /> ;��1� ,�, /sz ��Ly /°.1�6„�-.� ��-,.-� 9s���, yzs-7g'3-3s�� <br /> TENANT NAME CONTACT FOR PERtdIT PHONE <br /> C�ONTRACTOR ADDRESS � C�yIT�fYIZIP PHONE <br /> �,+/v�7��..�t� �'�fs'�S�vV�T1C �G"ri'� F�f� �'�T�" �vP��'Z/ %Ja�U� / 1{`-ZSy`Z�� � <br /> COtJTR.LICENSE S <br /> jy�, gN;so���z <br /> USE OF BUILDING HEAT SOURr,E �.ONi RACT PRICE OF WORK <br /> ��f J �Eleclric _Gas_Olher � �/�� � <br /> WORK DE:SCRIPTION <br /> /��/Y�i'�'� Q/ /7"u✓nci�L ,10,.� JLu �� �%<c�i"i"� �.,-.qG�.�. . <br /> 1� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF f�l%TURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathlub � Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Back(low preventer _ Heal pump <br /> Urinal _ Unit healer <br /> Drinking Fountain 6oiler <br /> Fioor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> I hereby cerili(y lhal I have read and examined lhis application and know lhe same to be lrue and correcL All provisions af laws and <br /> ordinaces goveming this type of work will be complied with whether speci(ied herein or not.The granling of a permit does not presume <br /> to give aulhoriry to violale or cancel the provision of any other slate or local law rec�ulaling conslruclion or lhe performance c�f <br /> conslruction.That I am aulhorized by lhe owner of this property to periorm lhe work for which applicalion is made and I comply with the <br /> Stale Conlraclors Law 1827 RCW and 29G.200 WAC. <br /> ��.1��//, .��,�;' " `_ <br /> igna ure of 6wned onlraclor/Authonzed Agenl Date <br />