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�-- PE�MIT APPLICe4TIOIV <br /> CITY O� EVERETT PERMET SERVIGES <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 `��2Z'-!7�ji <br /> SITE ADDRESS PARCEL TAX I.D.# �ERMIT# <br /> . 7 � L� � r� , o609-DSo <br /> LEG4L LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS CITYIZIP PHONE <br /> '� .1 �� ��Gi-:��a� �l�Z 5 3 0 �!' � <br /> TENANT NAME CONTACT FOR F�RMIT PHONE <br /> Sf�,� a r � k r:n��'� k �l S) y�a - �� <br /> CONTRACTUR ADDRESS CITY2IP � PH NE <br /> ��iYi�1aGYlr/� et.'G� �v��rS�lGtfflJN ��� � Harr�.S,�:, �ve-re'ft (Z��SJ ���c���iF�9 <br /> CONTR.LICENSEtl �aMME_ C �9 �'_S!�� �9���� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WOR;( <br /> ,/� / ` � Electric Gas_Other <br /> _IVILLl��I �:�vs�r.� l�1 — — — <br /> WORK DESCRIPTION <br /> R e v�ot �- �� Z ��C�l ,�-�,�jtt �� ._��' ��'�� , <br /> .�ze�G�",.�e r,yy ✓ -;� .���u,�.- .I'. <br /> PLUMBING M C AN�CAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathlub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> v Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes�vasher Clo'hes dryer <br /> Waler heater Range h�.od <br /> Sink(service/badmop/etc.) Ezhaust fan <br /> , Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> i _ Grease trap _ VJoodstove <br /> Roof drains Olfier _ <br /> Other <br /> CITY OF EVERETT IACAL SALES TN(CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application e�nd know the same to be true and coi recL All provisions of laws and <br /> ordinaces�overninc� Ihis type o(work will be complied with whelher specified herein or not.The grenting��f a permit does nol presume <br /> to give aulhority to violale or cancel the provision o(any other state or local la�v regulating construction o� the performance of <br /> construction.Tnat I am aulhorized by the owner of this property to peAorm lhe work for which application is made and I comply w:�h the I <br /> State Conlr�clors Law 18.�? RCW and 'Z96.200 WAC. <br /> �;-'.. __ � _ �--_ _ _ <br /> _/� ��9-2�z - �26 � <br /> Signa[areof OwnedContractor/Aulhorized Agenl " Dale <br />