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<br /> �°; I P�RIVIIT APPL�CATIt�N �
<br /> � '�y-05 I
<br /> CITY OF EVERETT PERMIT SERVICES �
<br /> 3200 CEDAP. STREET, EVERETT, WA 98201 � `
<br /> �" I 425-257-8810– FAX 425-257-8857–www.everettwa.org , 0 �
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<br /> : I APPLICATIOhS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS RE NOT ACCE2TED �
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<br /> `� I SITE ADDRESS� � PARCEL'fAX I.D.# PERMIT#
<br /> ,3�` ! I B(aZZJ Ft�// �� -o z� I
<br />� ;'i7. LEGAL LOTNO. 9LOCK TRACT I
<br /> � DESC.
<br /> � OWNER A�Df2ESS CITY/ZIP PfiONE
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<br /> �"kfi"�a TENANT NAME CONTACT FOR PERMIT PHONE
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<br /> � CON�RACT.OR ADDRE55 C;TY21P PHONE
<br /> -$Fdi I �!"y1P.-i^S�'O��i/yn�J� � Q� �� S � �U�Li'�� �Z�7��^6/3 !
<br />�� .�„4 CONTR.LICENSE# �8'y7 S'
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<br /> USE OF BUILUING HEAT SOURCE CONTRACT PRICE OF WORK
<br /> x �� _Electric _Gas_Olher
<br /> ` �i WORK DESCRIPTION
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<br /> ��,��;� PLUMBING MECHANICAL
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<br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM
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<br /> � Toilel A/C-air handling units
<br /> . �1 Bathlub Forced air systems
<br /> , :± _ Lavatory(wash basin) _ Gas piping
<br /> � Shower Water healer
<br /> Kilchen sink&disposal _ Gas fireplace
<br /> �- 1 Dishwasher Gas range
<br /> � ! Clothes washer Clothes dryer
<br />„;:�s; Laundryl�ay Rangehood ���
<br /> � ' '�=� _ Sink(serviceNadmop/etc.) _ Exhaust fan h��� .
<br /> Back(low�reventer _ Heat pump ti. ni
<br /> � Urinal Unil heatcr ��a , � �?
<br /> ,�,;',n _ Drinking Fountain _ Boiler '. y "
<br /> Floor drain _ Refrigera!ion ',+F� ,
<br /> � Grease trap _ Woodstove �"
<br /> � , Roof drains Olher_
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<br /> �, _ Olher _ , �� <
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<br /> �- ��, CITY OF EVERETT LOCAL SALES 7AX CO�E IS 9105 � ' ���K;_�sW
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<br /> t;t`�' ! �I I hereby ceritify that I have read and examined this appiication and know the s�me to be Uue and correcL All provisions of laws and •-,i
<br /> � ordinaces goveming this type of work will 6e complied wilh�vhether specified herein or not The grantinc of a permit does nol presume ` ��
<br /> ;_�} � to give aulhority to violate or cancel the provision of any ether siate or local law regulaling consWction or the performance of T" A
<br /> conslruction.That I am authorized by the owner of this properry lo perform the work(or which applicatinn is made and I comply wilh the
<br /> Stal� " n'tactors Law 1827 RCW and 296.200 WAC. -
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<br /> S�iure of Owner/ConlractodAuthorizsd Agent � Date �5 �`'
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