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LoTa� %Nnln����[��v� .��--3 3 <br /> � PIFR�111BT AP�LIC�4 i"IC�[V <br /> CITY OF EV�R�TT PERMIT SERVIC�S <br /> 3200 CEDAH STREET, EVERETT,WA 98201 ^��-(j-C7� <br /> 425-257-8810- FAX 425-257-8�57-www.evereriwa.org <br /> APPUCATIONS AFIE ACCEPTED FROM 0 AM T04 PM ��4� � -5--� <br /> � ----- . - <br /> SITE ADORESS PARCEL TAX I.D.i PER�F T• <br /> D / I/ , �, d�, - ���/ <br /> LEGA LO�NO. BLOCK TFIACTORSUBOM910NX . � <br /> OESC. <br /> OWNER RESS CfTY PHONE <br /> ��In��u,�T—�el��-rn��,-�r�le �'� �ax �30�-! , �1�Ar�� vi�L� t��r� 7�-70 <br /> TENANT NMIE CONTACT FOR PEflkR PHONE <br /> I l /�}/�/9 �E�S��E� EdANLI�ik �nRi�ycill��k1i�E � <br /> �Ewr6�.c L'�u NTY��� �cNSt72UC-RDA(� I nIL• <br /> CONTR.L�CENSE R <br /> rt.,�r-, ifi�A�l��l� i�n ✓3nx i3o� — /rIAQ� �i� �f 9Fsa7 <br /> USE OF BUtLDING HEAT SOURCE I COHiRACT PRICE OF WORK <br /> 5 �Q � _Electric �Gas_Other <br /> WORK DESCHIPTION ' n�, <br /> N�f,1 C6Y�S�l�G�l�V1 - Sr � �;'7j 1 L ���.7 <br /> ` , v •>J C`-� � V � �-(J � - C��C-' C-'CG �� ' <br /> PLUiIAAI MECHAN{CAL <br /> N0. TYPE OF FlXTURE OR ITEM NO. TYPE OF Fl7iTURE OR REN <br /> 3 Toilet A/C—air h3ndling units <br /> � BatMub Farced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> 8hower � Water hea�er <br /> 1 Kitchen sink&disposai Gas tireplace <br /> � Dishwasher Gas range <br /> I Clolhes washer � Clothes dryer <br /> � Wa�er heater � Range hood <br /> Sink(service/baqmop/etc.) �_ Exhausl tan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> i Drinkinp Fountain Boiler <br /> Floor drain Refigeration <br /> Grease trap Woodstove <br /> � = Roof drains = Other <br /> Other <br /> CITV OF EVERETT LOCAL SALES TIlX CODE IS 3105 <br /> I hereby coritify ihal I have read and examined this application and know ihe same to W:irue and cortect. All provisions of laws antl <br /> ordinaces goveming this type ot work will be complied with wFiether specitied herein or not.The granting of a permii does not presume <br /> to give authority to violate or cancel the provision of any other state or Iocal law repulating construction or ihe performance of <br /> construction.That I am authorized by the owner oi this property to perform the work for which app!ication is made and I comply with the <br /> State Contractors Law 18.27 RCW anC 296200 WAC. <br /> Signature of Ovmer/Contractor/Authorized Agent Date <br />