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PEt2MIT APPLICATIO�! <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 6 ` �9 —D <br /> 425-257-8810 — FAX 425-257-8857—www.everethva.org 7 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �7��39 <br /> SITE ADDRESS �� � PARCEL TA:;I.D.# P RMIT# _ <br /> a� L.o� . ✓6 ��ti� 9u ` �� r� zroo <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYI�IP PHONE t��Zjp�-Sy)i <br /> ! <br /> ��,a�►,�s ��'� za v i� s�'�� �-����� �i��.�.�_ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Jc J'Iz C �! / ���c?J'r �11.i�-t 1 u -.T 9�7 <br /> CONTRACTOR � ADDRESS CITY2IP PHONE <br /> 7/}� Oh�'hc, �/�S-F�c -l�J <br /> �NTR.LICEIJ$E# (���IU ��I�. �a � �/7 � L 1 �T'/�2�Z <br /> �i C;�yf 97�4�D Vr�kiof<, r .,- � . �r�'1�o <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �, ` � i� �rj.f4i � X Eleclric _Gas_Other Y.�� �ti Fi <br /> V�J �� �'/ LG t <br /> WORK DESCRIPTION �L�'""" <br /> �.. G r'�,�tl�a c f�,;� �-� G he�.� �o y h �?Gr+�z <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTUR[OR ITEM <br /> -i � A/C-air handling units <br /> Toilet " <br /> 6alhlub%. Forced air syslems <br /> Lavatory (wash basin)_; � Gas pipinc� <br /> Shower / Waler heater I <br /> � itchen sink&disposa� ) �t Gas fireplace <br /> ishwasher i `� Gasrange <br /> lolhes washer � �_ Clothes dryer � <br /> - � Waler heater � Range hood � <br /> Sink(serviceibadmop/etc.) Exhaust fan¢. <br /> ,�'"� Backflow preventer Heat pump <br /> Urinal � Unil healer <br /> Drinking Fountain � Boiler <br /> 'Floor drain T— Refrigeration <br /> � Grease Vap Woodstove <br /> % Roof drains =I Other <br /> Other <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined lhis application and know the same to be true and correct All provisions of laws and <br /> ordinaces goveming this lype of work will be complied with whelher specified herein or not The granting of a permit does nol presume <br /> lo give aulhonty lo violale or cancel the provision of any other slate or local law regulating conslruction or the pertormance of <br /> construction.Thal I am aulhorized by the owner of this property lo periorm lhe work tor which applicalion is mado and I comply wilh lhe <br /> Stale Contracfors Law tf1.27 RCW and 296200 WAC. <br /> ��.� %�� j e� Z <br /> Signalure o(OwnedCo raclor/Aulhonzed Agent Dale <br />