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PE�RI��IT APPLICATIOM ����`�,, ��"`'� <br /> CITY OF EVERETT PERMIT SERVICES �.���`� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � ����� <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org �p _. �3-A�o <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �i�,l) �1(��� "�'�� <br /> SITE AD�RESS - PARCEL TAX I.D.# P RMI'i# <br /> � ��,0�� }�nil-_� �f.", , . ,, r. r ., IC:,,.. I 1`l�I�`1 ��D03 � �l'O - �� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. 1 '� 'T"� ����^. <br /> OWNER i�r` ':Y�rt� i��L� AODRE55 CITY/ZIP PHONE <br /> ��i�-li., ,��_t�� A C�t�H�� �'0 f?a;� 12t•�� �.f�,'r;:.. `.,�^�;., t,. wV1 'tiZ°,7: N�S ��'40',= <br /> TENANT NAME CONTACT FOR PERMIT Q110 E <br /> ��r �5�-�'- I 5G �7,': <br /> �1:� -� •`1 Y�1� c44� (1� <�;n("�,",(_,. �. � U�� _ =' f-�'_.�-' ;-r <br /> CONTRACTOR^�1�'` _ �` r : II ADDRESS CIN21P PHONE <br /> - '�: �L! . r , <br /> -, � �• .t�p..'c.,�l� ''.(''.� (!'.,�c� ' i. � � .. � L:`� � . . . <br /> CONTR.LICENSE#ij + � �* ���� ��" . � . . � � ' ��' ., . �7 ,� � <br /> 1 L�,2.1 i f�';9 �. -:. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> K 1 <br /> �'��.�� '�lectric _Gas_Other � �� J�)U ��: � '' <br /> WORK DESCRIPTION , <br /> 1 � C <br /> Y,;�(� r ':�� ��� . nr f.r , , ' ' . . ,.�.{ � , _ . .. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUI:E OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unifs <br /> J BalhWb T Forced air systems <br /> ;_� Lavalory(wash basin) Gas piping <br /> I Shower � Waler healer <br /> I Kilchen sink&disposal _ Gas fireplace <br /> I Dishwasher Gas ran�e <br /> I Clolhes washer � Clolhes dryer <br /> �_ Waler heater � Ranc�e hood <br /> Sink(service/badmop/etc.) 5 Exhaust fan <br /> BackOow preventer Heat pump <br /> Urinal Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigcralion <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify ihal I have read and examined lhis application and know lhe same to be true and correcL All provisions o(laws and <br /> ordinaces governing Ihis type of work will be complied wilh whelher specified herein or not.Tho granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any olher stale or local law regulating conslruclion or the peAormance oF <br /> construction.That I am authorized by the owner oi ihis property lo pedorm Ihe work for which applicalion is made and I comply wilh the <br /> S tr6oqtracbrs Lavt18.27 RCW and�296.200 WAC. <br /> � `- �- lS -U6 <br /> SignaWre of Owner/ onlrac or/Au fiorized c�e t Dalo t <br /> �� <br /> —A <br />